Carlos J. R. Simal

Premature acute myocardial infarction in a child with nephrotic syndrome.

Abstract We report a case of acute myocardial infarction in a nephrotic child. A 7-year-old boy with a 4-year history of steroid-unresponsive nephrotic syndrome due to mesangial proliferation disease presented with acute vomiting and chest pain. An electrocardiogram showed ST elevation and pathological Q waves in leads consistent with anterior and septal myocardial infarction. Subsequent cardiac catheterization showed no evidence of atherosclerotic coronary artery disease, and thrombotic occlusion of the anterior descending coronary artery was the likely cause of the event. Myocardial scintigraphy showed extensive myocardial damage. The child had no long history of extreme hypercholesterolemia or hypertriglyceridemia. The case suggests that children with long-lasting nephrotic syndrome may be at increased risk for ischemic cardiovascular events, due to hyperlipidemia as well as a hypercoagulability state. The literature is reviewed regarding the relationship between nephrotic syndrome and the incidence of ischemic heart disease.

Outcome of apparent ureteropelvic junction obstruction identified by investigation of fetal hydronephrosis.

Objectives: The purpose of the study was toevaluate the outcome of prenatally detectedureteropelvic junction obstruction (UPJO)managed with a more conservative protocol.Methods: The records and imaging studies of 77consecutive neonates with UPJO identified by fetal hydronephrosis werereviewed. A nonoperative approach wasattempted in patients with mild/moderate pelvicdilatation, renal units with good functionas ascertained by DMSA scan and anon-obstructed pattern on DTPA. Otherwise, thepatients were managed surgically bypyeloplasty. Both groups were prospectivelyfollowed and the imaging studies were performedbefore and after the initial approachand at one-year intervals thereafter.Results: Of the 77 infants (85 units), 39 weresubmitted to surgery (33 pyeloplasty and 7 nephrectomy) and 38 were conservativelymanaged. During follow-up, 9 (24%) of 38 patients in the non-operative group presentedrenal function deterioration and 3 presented with urinary infections and were submitted topyeloplasty. Of the 39 patients surgically managed, 76% presented improvement ofhydronephrosis and 90% showed a non-obstructed pattern on diuretic renography. Thedifferential renal uptake, as measured by DMSA scan, remained stable in the three groupsanalyzed (conservative, initial pyeloplasty, and delayed pyeloplasty). Therewas a minimal improvement in those units submitted to pyeloplasty with impairedrenal function at baseline (< 40%). Mean renal uptake was 28.6% at admission and33.9% at the end of follow-up. Conclusion: There was a wide spectrum ofureteropelvic junction stenosis. Surgical intervention in a subgroup of patients withsevere hydronephrosis and impaired function may possibly improve or preserve renalparenchyma. Conversely, conservative management and clinical follow-up are safe anddesirable for the subgroup with mild/moderate pelvic dilatation and preservedrenal function.

Preparation of crotalus venom radiolabeled with technetium-99m as a tool for biodistribution study

Technetium-99m (99mTc) has been the radionuclide of choice for nuclear medicine procedures and experimental research. Because of its optimal nuclear properties, 99mTc is suitable for high efficiency detection with the advantage of reduced radiological waste. Crotalus venom (CV) has been shown to reduce tumors in clinical studies and tissue distribution studies are very important for clinical use. The goal of this work was to obtain CV labeled with 99mTc which preserves its biological activity. After labeling, biological activity was assessed by hemolytic activity evaluation. Labeled and crude venom caused indirect hemolysis provided that the incubation medium contained an exogenous source of lecithin. High yield radiolabeled-CV was obtained and biological activity was preserved. The results suggest that 99mTc-CV can be a useful tool for biodistribution studies.

Atividade fagocitária do sistema mononuclear fagocitário na gravidez

Alterations of the immune function during the pregnancy are not well understood. To assess the influence of pregnancy on the phagocytic function of the reticuloendothelial system twenty adult female rats were divided into two groups: Group 1 (n=10) - control, Group 2 (n=10) - pregnant rats. The assessment of the phagocytic function of the reticuloendothelial system was by the uptake of sulphur colloid labeled with Tc99m by the reticuloendothelial system organs as well as to assess the permanence of the radio isotope in blood clots. The weights and radioactive levels of the samples were measured. Histologic analyses of these organs were performed as well. The results were compared using the Student t-test, with significance at p<0.05. The scintigraphic values were higher in the liver followed by spleen and lung. The blood clot presented with only a low amount of radiation. The pregnant rats registered lower radiation levels in the liver and higher in the lung when compared with the control group. The histo-architecture of the studied organs did not show any alterations. Pregnancy reduces the phagocytic function of the liver but increases the role of the reticuloendothelial system function of the lung.