Use of Percutaneous Ethanol Injection Therapy for Recurrent Secondary Hyperparathyroidism after Subtotal Parathyroidectomy

We evaluated the efficacy of percutaneous ethanol injection therapy (PEIT) as a therapeutic option for recurrence of secondary hyperparathyroidism after subtotal parathyroidectomy in ESRD patients. Six patients underwent PEIT. A mean of 1.3 ± 0.8 ethanol injections was performed. Nodular volume was 1.5 ± 1.7 cm3, and 2.8 ± 2.8 cm3 of ethanol was injected per patient. After ethanol injection PTH decreased significantly (1897 ± 754 to 549 ± 863 pg/mL (P < .01)). There was also a reduction in serum calcium, phosphorus and calcium-phosphorus product. A positive and significant correlation was found between nodular volume with ethanol injected and time from parathyroidectomy. Only one patient required hospitalization due to severe hypocalcaemia. In other two cases, local discomfort and temporary mild dysphonia were registered. PEIT is an effective treatment to control recurrences of secondary hyperparathyroidism postsubtotal parathyroidectomy

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

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Disorders of bone and mineral metabolism after renal transplantation

A 27-year-old transplant patient was admitted to the Hospital PrivadoCentro Medico de COrdoba for a core decompression procedure on both femoral heads and a bone biopsy of the iliac crest. He had received a cadaveric graft 18 months prior to this admission after receiving chronic hemodialysis for 14 months. His renal failure was due to chronic glonierulonephritis of undefined cause. At the time of transplantation, his intact PTH serum level was 132 pg/dl and the serum aluminum concentration was 139.6 g/liter (Table 1). He was given immunosuppression therapy of steroids and cyclosporine. Diuresis began on the seventh postoperative day after a period of presumed acute tubular necrosis. Acute rejection (Banif I/lI on the biopsy specimen) occurred on postoperative day 12, and he was given a series of intravenous boluses of methylprednisolonc (250 mg twice daily for 3 days). The rejection resolved and he was discharged from the hospital on postoperative day 20; his serum creatinine was 2.2 mgldl.Fil: Massari, Pablo U. Universidad Católica de Córdoba. Facultad de Ciencias de la Salud; Argentin

Una vida dedicada a la tuberculosis: Gumersindo Sayago

Gumersindo Sayago fue un iniciador e impulsor de la Escuela Tisiológica de Córdoba que alcanzó trascendencia internacional y que inauguró, para América Latina, los programas de formación de postgrado.Estudio en las facultades de medicina de la UBA y de Córdoba. Son años turbulentos (1918) y adhiere rápidamente a las ideas reformistas y se transforma en uno de sus líderes. Presidió el Centro de Estudiantes y viaja a Buenos Aires a entrevistarse con el ministro de Educación y con el presidente Yrigoyen. Firma el Manifiesto Liminar. Pronto renuncia a la actividad política estudiantil desconociéndose motivos, pero sabemos que quiere dar testimonio de esos ideales reformistas, uno de los cuales es el anhelo vehemente de lograr la participación de la Universidad en el estudio y en la solución de los problemas actuales. En marzo de 1921, obtiene su título de doctor en medicina con tesis titulada: La tuberculosis en la provincia de Córdoba. Fue médico del Dispensario Antituberculoso (adjunto al Hospital Transito Cáceres de Allende). En 1933, la Universidad crea el Instituto de Tisiología. Sayago asume su dirección y produce desde él gran cantidad de publicaciones2. Aparece, además, la cátedra de Tisiología, primera en América Latina, que Sayago conducirá casi hasta su muerte. Estas cuatro instituciones, Cátedra, Instituto, Dispensario y Hospital Tránsito Cáceres de Allende, las dos primeras universitarias y estas dos ́últimas privadas, trabajan bajo la dirección de Sayago en forma coordinada. Allí comienza la famosa serie de cursos de tisiología, de realización anual, con gran asistencia de argentinos y extranjeros.Fue un ejemplo de liderazgo médico, de educador y publicista.Fil: Massari, Pablo U. Universidad Católica de Cuyo. Facultad de Ciencias Médicas, Argentina

Epidemiology of renal and cardiovascular risk factors in Toba aborigines

Objectives. To detect, educate, and control cardiovascular (CVD) risk factors, diabetes mellitus, hypertension, obesity, central obesity, and renal damage markers such as glomerular filtration rate (GFR) and proteinuria within a population of Toba aborigine people who live in the outskirts of Resistencia city, Chaco Province, Argentina. Methods. A sample was selected from four Toba communities. Blood and urine samples were drawn in their own homes. Proteinuria was considered positive when a urinary protein/urinary creatinine rate (uPr/uCr) ≥ 0.20. GFR was estimated by Levy formula, and the stages of chronic kidney disease (CKD) were as defined in the National Kidney Foundation Guidelines. Results. In all, 385 subjects were included, 36% males, mean age=36.1 years old. The prevalence of CVD risk factors was as follows: hypertension in 97 (25.2%), proteinuria in 84 (21.8%), CKD in 93 (24.2%) [Stage 1 in 26 (6.8%), Stage 2 in 46 (12%), and Stage 3 in 21 (5.5%)]. No subjects showed CKD Stage 4 or 5. Being overweight was found in 129 (33.5%), obesity in 82 (21.3%), central obesity in 190 (49.4%), and diabetes in 8 (2.1%). The presence of CKD was associated with an increased prevalence in central obesity, hypertension, and diabetes, but not obesity. The adjusted relative risk for proteinuria was 2.79 (p ≤ 0.008) in subjects of at least 45 years of age, compared to subjects under 25 years. Conclusions. This group of aborigines showed a high prevalence of proteinuria and CVD risk factors and CKD not related to diabetes.Fil: Bianchi, María E. Facultad de Medicina, Universidad Nacional del Nordeste, ArgentinaFil: Farías, Eduardo F. Instituto de Cardiología, Juana F. Cabral, Corrientes, ArgentinaFil: Bolaño, José. Hospital Julio C. Perrando, Ministerio de Salud Pública de la Provincia del Chaco, ArgentinaFil: Massari, Pablo U. Universidad Católica de Córdoba. Facultad de Ciencias de la Salud; Argentin

The spectrum of renal osteodystrophy in Argentina [Espectro bioquímico e histológico de la osteodistrofia renal en Argentina]

Between 1994-2001 we have performed 57 bone biopsies for diagnostic purposes in symptomatic CRF patients. We analyzed here 52 samples where the material was optimal for study, and divided them into 2 periods according to when the biopsy was performed: 1994-1996 and 1997-2001, to verify changes in the spectrum of renal osteodystrophy. Mean serum values were: serum calcium 9.9 ± 1.8 mg/dl, phosphate 5.8 ± 3.2 mg/dl, alkaline phosphatase 693.9 ± 968.9 UI/L, iPTH 562.0 ± 598.5 pg/ml, serum aluminum 65.7 ± 79.3 ug/L and bone aluminum 22.8 ± 22.4 ug/g. Hyperparathyroidism was the most common histological diagnosis as severe in 13 patients (25%), or as mild in 14 (27%). Ten patients had osteomalacia (19%), adynamic bone disease was diagnosed in 5 (9.6%) and mixed renal osteodystrophy in 10 (19.2%). Low bone turnover patients showed higher bone and serum aluminum than high bone turnover patients. We observed a relative increment in high turnover bone disease in the later period (1997-2001) without changes in low turnover bone disease. These data showed a high prevalence of hyperparathyroidism and aluminumrelated low turnover bone disease, with no significant changes between the two time-periods analyzed here.Fil: Douthat, Walter Guillermo. Universidad Católica de Córdoba. Facultad de Ciencias de la Salud; ArgentinaFil: Garay, Gabriela. Universidad Católica de Córdoba. Facultad de Ciencias de la Salud; ArgentinaFil: De Arteaga, Javier. Universidad Católica de Córdoba. Facultad de Ciencias de la Salud; ArgentinaFil: Fernández Martín, J.L. Universidad de Oviedo. Servicio de Metabolismo Óseo y Mineral, Instituto Reina Sodía de Investigación, Hospital Universitario Central de Asturias; EspañaFil: Cannata Andía, J.B. Universidad de Oviedo. Servicio de Metabolismo Óseo y Mineral, Instituto Reina Sodía de Investigación, Hospital Universitario Central de Asturias; EspañaFil: Massari, Pablo U. Universidad Católica de Córdoba. Facultad de Ciencias de la Salud; Argentin

Percutaneous ethanol injection therapy in post-transplant patients with secondary hyperparathyroidism

Persistent hyperparathyroidism is frequent in postrenal transplant patients. Percutaneous ethanol injection therapy (PEIT) is an alternative for treatment of patients with secondary hyperparathyroidism but it was not described in postrenal transplant patients. We report our experience with PEIT to control hyperparathyroidism in the post-transplant period. We performed PEIT under ultrasonographic guidance and local anesthesia in eight patients because of persistent secondary hyperparathyroidism after renal transplantation. Indications for PEIT were: high intact parathyroid hormone (iPTH) levels with hypercalcemia, hypophosphatemia, osteopenia and/or bone pain. All patients had at least one visible parathyroid nodule by ultrasonography. Biochemical assays were performed immediately before PEIT, between 1 and 7 days after last PEIT, and a mean of 8.0 ± 2.8 months after PEIT. Serum iPTH and calcium levels decreased significantly after treatment and remained unchanged until final control. Serum iPTH decreased from 286.9 ± 107.2 to 154.6 ± 42.2 pg/ml (P < 0.01) after PEIT (percentual reduction 36.5 ± 9.5%). This response was significantly correlated to total ethanol volume used (r: 0.94, P < 0.0001). Hypercalcemia disappeared in six of eight patients treated. Only minor complications were registered. There were no changes in renal function related to the treatment. Our findings show that PEIT is a useful and safe alternative for patients with persistent post-transplant secondary hyperparathyroidism.Fil: Douthat, Walter Guillermo. Universidad Católica de Córdoba. Facultad de Ciencias de la Salud; ArgentinaFil: Orozco, Santiago E. Department of Radiology, Hospital Privado-Centro Médico de Córdoba, Córdoba, ArgentiFil: Maino, Pablo. Department of Radiology, Hospital Privado-Centro Médico de Córdoba, Córdoba, ArgentinaFil: Cardozo, Gabriela. Universidad Católica de Córdoba. Facultad de Ciencias de la Salud; ArgentinaFil: Arteaga, Javier de. Universidad Católica de Córdoba. Facultad de Ciencias de la Salud; ArgentinaFil: Fuente, Jorge de la. Universidad Católica de Córdoba. Facultad de Ciencias de la Salud; ArgentinaFil: Chirchiu, Carlos R. Universidad Católica de Córdoba. Facultad de Ciencias de la Salud; ArgentinaFil: Massari, Pablo U. Universidad Católica de Córdoba. Facultad de Ciencias de la Salud; Argentin