[Acute renal insufficiency. Diagnostic algorithm].
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Biomedical subjects
Publications and source records attributed to A M Carrasco.
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Aiming to assess the autoimmune origin of certain thyroid diseases, we studied the phenotypic composition and the ability of intrathyroidal lymphocytes to a re-induce HLA-DR expression on autologous thyrocytes coming from patients with graves's disease, nodular goiter and papillary thyroid carcinoma. Lymphocytes coming only from graves's disease patients were capable of reinduce HLA-DR expression on autologous thyrocytes (24.1 +/- 13.6 vs 1.5 +/- 2.54% in nodular goiter and carcinoma), as interferon gamma did (17.4 +/- 8.34%). Phenotypic characterization showed a significant decrease of T-CD3 (total lymphocytes) and T-CD4 (helper) in lymphocytes coming from patients with nodular goiter and carcinoma, and a marked reduction of T-CD8 (suppressor) in lymphocytes coming from patients with graves disease. Thus the T-CD4/T-CD8 ratio varies according to the etiology of the thyroidal disease. The lack of suppressor activity would explain why cells coming only from patients with graves disease, show marked HLA-DR expression. These findings give little support to the autoimmune origin hypothesis for nodular goiter and thyroid carcinoma.
We report a 63 year old woman with a rapidly progressive renal failure and fever of unknown origin. Laboratory tests showed anemia, increased ESR and a urine analysis compatible with a glomerular disease. Antineutrophil cytoplasmic autoantibodies were positive with a perinuclear pattern. Kidney biopsy showed an autoimmune crescenteric glomerulonephritis. The patient had a bad evolution, dying after a massive hemoptysis. The necropsy showed a disseminated arteritis without compromise of bronchial vessels. The oligosymptomatic presentation of this patient, bearing in mind the anatomo-pathological findings, is noteworthy and emphasizes the usefulness of serological markers as antineutrophil cytoplasmic autoantibodies in the differential diagnosis.
Thirty six patients with stage IV lymphoproliferative diseases, were studied with a panel of monoclonal antibodies. There were 26 B-Lymphoproliferative Diseases (BLD): 11 B-chronic lymphocytic leukemia, 15 B-cell non Hodgkin lymphoma and 10 T-Lymphoproliferative Diseases (TLD): 4 T-cell non Hodgkin lymphoma, 4 adult T-cell leukemia/lymphoma, 1 T-chronic lymphocytic leukemia and 1 Sezary Syndrome. HLA-DR and CD 19 (B4) were the most common antigens found in BLD. CD4 + CD8 was the most common phenotype in TLD. 13 out of 26 BLD and 1 out of 10 TLD, patient were alive at the end of a 4 year observation period. Our study shows that immunophenotyping is a very useful diagnostic test in lymphoproliferative diseases. Along with cytology and histopathology, it can better define different pathologic groups and lead more specific treatments.
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OBJECTIVE: The aim of this study was to evaluate the effects of a combined 25 mmol/L bicarbonate/15 mmol/L lactate-based solution (Bic/Lac), compared to a 35 mmol/L lactate solution (Lac)--the most commonly used solution for patients in southern Europe--on the venous plasma bicarbonate level in patients treated with continuous ambulatory peritoneal dialysis (CAPD). DESIGN: This was a randomized, parallel, controlled, open-label study, with patients studied for a period of 3 months preceded by a 1-month baseline and followed by a 1-month follow-up. Patients used the 35 mmol/L lactate solution during baseline and follow-up periods. SETTING: Four Spanish nephrology centers. PATIENTS: Thirty-one (20 Bic/Lac, 11 Lac) well-dialyzed (creatinine clearance > 55 L/week/1.73 m2 body surface area) CAPD patients. INTERVENTIONS: Blood samples were taken for biochemistry tests at all visits. A physical examination was completed at baseline and month 3, and a medical update was completed after 1, 2, and 3 months, and at the follow-up visit. Adverse-event monitoring and notation of prescription changes were carried out continuously. MAIN OUTCOME MEASURE: Effect on venous plasma bicarbonate level. RESULTS: Venous plasma bicarbonate rose by 3.1 mmol/L (confidence intervals 1.6-4.8),from a baseline level of 23.0 mmol/L during the treatment period in those patients treated with Bic/Lac (p < 0.05 vs Lac). The number of acidotic patients (venous plasma bicarbonate < 24 mmol/L) was statistically significantly reduced at every treatment period visit in the Bic/Lac group (p < 0.05). There were no adverse findings with respect to vital signs, physical examination, or clinical symptoms, apart from one death in the control group. CONCLUSIONS: The new Bic/Lac solution allowed better correction of acid-base status than the lactate solution.
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