[Ewing's tests validation for autonomic dysfunction assessment]. / Validação dos testes de Ewing para avaliação de disfunção autonômica.

The medical literature on the evaluation of autonomic dysfunction accumulated discordant results in the past decades, accentuating the need of validating the proposed tests. The Ewing's tests for studying autonomic abnormalities received increasing acceptance, as they recognize not only cardiovascular reflexes damage but lesions in any other segments of the autonomic nervous system. We proposed to validate them in our population by analysing their results on 30 normal individuals and 23 long-standing diabetics. Our results show that the five tests are highly sensitive and specific, reproducible, use simple and available office material, and fulfil their purpose.

[Organ donation for transplant: a human response to death]. / Doação de órgãos para transplante, uma resposta humana à morte.

Dialysis instead of kidney transplantation remains the available treatment for most of the uremic Brazilian population. The low percentage of transplants of cadaver donors (20%) that occurs in Brazil is insufficient to prevent the progressive accumulation in the number of individuals requiring transplants. Our investigation shows that 86.6% of the people of Londrina know the importance of organ donation but actually only 36.4% would sign a donor card. Most of them mentioned not being fully acquainted with the matter, a fact to suggest we should increase our efforts at extending to the population further knowledge on death and dying.

Insuficiencia renal aguda pos-transplante renal. / Acute renal failure after kidney transplantation

Dentre 114 pacientes submetidos a transplante renal, os autores observaram a ocorrencia de disfuncao renal pos-operatoria do tipo necrose tubular aguda em 16% dos receptores de rim de doador vivo aparentado e em 50% dos casos em que o doador era descerebrado. A hemodialise pos-operatoria, 3 vezes por semana, com heparinizacao continua na dose de 10 unidades/ kg/hora, nao aumentou a morbidade, enquanto permitiu aguardar-se a recuperacao de diurese adequada, de sorte que a funcao renal, medida pela creatinina plasmatica, estava igual a do grupo sem insuficiencia renal, exceto nos poucos casos de necrose tubular aguda observados quando o doador era vivo e aparentado. Ao final do primeiro ano de observacao houve maior perda renal por agressao imunologica irreversivel naqueles pacientes que tiveram insuficiencia renal aguda

Anestesia em pacientes com insuficiencia renal e uremia. / Anesthesia in patients with renal failure and uremia

Estudamos, retrospectivamente, 52 pacientes uremicos, por insufuciencia renal cronica, submetidos a 102 anestesias para cirurgias de grande porte (duracao media 195.5 +/- 76,3 minutos), analisando e comparado as alteracoes da potassemia durante diferentes tecnicas anestesicas. Hemodialise foi realizada 12 horas antes da cirurgia, exceto quando os pacientes eram admitidos para transplante de rim de cadaver, nos quais o objetivo era corrigir as alteracoes de azotemia e obter, com transfusao de hemacias, valores de hematocritos em torno de 25% (X = 27.0; DP 6,6); o potassio serico que antecedeu a cirurgia foi de 4.6 =/- 0,9 mEq/1. A associacao anestesica mais comumente empregada foi halotano, succinilcolina venosa continua (63% dos casos), seguindo-se a adicao de oxido nitroso e succinilcolina venosa continua.Nao houve obito anestesico apesar de duas paradas cardiacas e dos tres episodios de insuficiencia respiratoria imediata, que foram de curta duracao e de recuperacao espontanea. Ocasionalmente, a potassemia pos-operatoria imediata aumentou de 1.4 mEq/1, porem, em media, as alteracoes nao foram significativas e nao tiveram correlacao com as paradas cardiacas observadas

Kidney transplantation in leprosy

despite the high frequency of renal involvement associated with Hansen's disease and the persistent occurrence of leprosy, especially in the underveloped countries, reference to kidney transplantation in these patients is rare. Secondary amyloidosis and a nephritic process possibly mediated by immune complexes are present in one-half of the leprosy pateints studied either by autopsy or by kidney biopsy.