RESUMO
Patients receiving cadaveric kidney transplants often experience delayed graft function. As iodinated contrast media injection (ICMI), necessary for cerebral angiography, which is often used to diagnose brain death, can be nephrotoxic, we compared renal function recovery (RFR) and 1-year and long-term graft survival according to the method used to diagnose brain death. Data from 9921 cadaveric kidneys, transplanted between 1 January 1998 and 31 December 2003, were retrieved from the French National Registry for organ donation. We defined RFR as the number of days for the recipient to reach a plasma creatinine less than 250 mumol/l, and/or a 24-h urine output greater than 1000 ml. RFR and 1-year and long-term graft survival were compared between four different donor groups (according to ICMI and diabetes mellitus). A total of 41.5% of deceased donors received ICMI before organ procurement and 1.95% of them were diabetic. History of ICMI or diabetes in the donor did not influence RFR or 1-year graft survival. Long-term graft survival was decreased in the group of patients transplanted with a diabetic graft as compared to patients transplanted with a non-diabetic graft (P=0.001). History of ICMI in the donor did not affect long-term graft survival in the non-diabetic donor group (P=0.2); however, in the diabetic group, ICMI tended to decrease long-term graft survival (P=0.056). ICMI did not affect RFR or graft survival in non-diabetic deceased donors. However, its use in diabetic deceased donors requires further study.
Assuntos
Meios de Contraste/farmacologia , Sobrevivência de Enxerto/fisiologia , Transplante de Rim/estatística & dados numéricos , Distribuição por Idade , Cadáver , Bases de Dados Factuais , Diabetes Mellitus/fisiopatologia , Feminino , Rejeição de Enxerto/mortalidade , Humanos , Transplante de Rim/mortalidade , Transplante de Rim/fisiologia , Masculino , Análise Multivariada , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Distribuição por Sexo , Fatores de Tempo , Obtenção de Tecidos e Órgãos , Transplante Homólogo , Resultado do TratamentoRESUMO
A cluster of cases of Candida albicans candidaemia in a surgical intensive care unit was investigated. The probability of such a cluster during a single month was highly significant compared with the frequency of candidaemia in the previous year. A molecular typing method, based on length analysis of three (EF3, CDC3, HIS3) microsatellite-containing regions, was used to investigate isolates from patients in and outside the ward. This demonstrated the involvement of different strains, indicating the absence of cross-transmission among patients. Results of microsatellite typing can be obtained almost in real-time, which is particularly useful in an outbreak context.
Assuntos
Candida albicans/isolamento & purificação , Candidíase/diagnóstico , Infecção Hospitalar/diagnóstico , Surtos de Doenças , Idoso , Candida albicans/genética , Candidíase/sangue , Infecção Hospitalar/sangue , Humanos , Unidades de Terapia Intensiva , Masculino , Repetições de Microssatélites/genética , Pessoa de Meia-Idade , Distribuição de PoissonRESUMO
We report a case of nefopam intoxication in a severely malnourished postoperative intensive care patient with profound hypoprotidemia. Nefopam induced agitation and confusion associated with anticholinergic symptoms such as tremor, hypertonia, mydriasis, and tachycardia. All these symptoms disappeared after withdrawal of the drug. Nefopam should be considered as a possible cause of confusion in postoperative patients.
