DMI - Departamento de Medicina Integrada

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A heterotrimeric GProtein, G«i-3 , on Golgi membranes regulates the secretion of a heparan sulfate proteoglycan in LLC-PKI epithelial cells
(The Journal Of Cell Biology, 1991) Almeida, Jose Bruno de; Stow, Jennifer L.; Narula, Navneet; Holtzman, Eliezer J.; Ercolani, Louis; Ausiello, Dennis A.
A heterotrimeric Gai subunit, «i- 3 , is localized on Golgi membranes in LLC-PKI and NRK epithelial cells where it colocalizes with mannosidase II by immunofluorescence . The M-3 was found to be localized on the cytoplasmic face of Golgi cisternae and it was distributed across the whole Golgi stack. The a;_3 subunit is found on isolated rat liver Golgi membranes by Western blotting and Gai -3 on the Golgi apparatus is ADP ribosylated by pertussis toxin. LLCPKI cells were stably transfected with GO;-3 on an MT1, inducible promoter in order to overexpress ai-3 on Golgi membranes. The intracellular processing and constitutive secretion of the basement membrane heparan sulfate proteoglycan (HSPG) was measured in LLC-PK, cells. Overexpression of ai-3 on Golgi membranes in transfected cells retarded the secretion of HSPG and accumulated precursors in the medial-trans-Golgi . This effect was reversed by treatment of cells with pertussis toxin which results in ADP-ribosylation and functional uncoupling of Gai-3 on Golgi membranes. These results provide evidence for a novel role for the pertussis toxin sensitive Gai-3 protein in Golgi trafficking of a constitutively secreted protein in epithelial cells
Purified epithelial Na+ channel complex contains the pertussis toxin-sensitive Gai-3 protein
(Elsevier, 1992) Almeida, José Bruno de; Ausiello, Dennis A.; Stow, Jennifer L.; Cantiello, Horacio F.; Benos, Dale J.
We have recently demonstrated that the amiloride-sensitive Na+ channel in the apical membrane of the renal epithelial cell line, A6, is modulated by the alpha i-3 subunit of the Gi-3 protein. We also showed that a 700-kDa protein complex can be purified from the membranes of A6 epithelia which (a) can reconstitute the amiloride-sensitive Na+ influx in liposomes and planar bilayer membranes and (b) consists of six major protein bands observed on reducing sodium dodecyl sulfate-polyacrylamide gels with molecular masses ranging from 35 to 320 kDa. The present study was undertaken to determine if the alpha i-3 subunit was a member of this Na+ channel complex. G alpha i structure and function were identified by Western blotting with specific G alpha i subunit antibodies and Na+ channel antibodies, through ADP-ribosylation with pertussis toxin, and by immunocytochemical localization of the Na+ channel and G alpha i proteins. We demonstrate that two protein substrates are ADP-ribosylated in the 700-kDa complex in the presence of pertussis toxin and are specifically immunoprecipitated with an anti-Na+ channel polyclonal antibody. One of these substrates, a 41-kDa protein, was identified as the alpha i-3 subunit of the Gi-3 protein on Western blots with specific antibodies. Na+ channel antibodies do not recognize G alpha i-3 on Western blots of Golgi membranes which contain alpha i-3 but not Na+ channel proteins, nor do they immunoprecipitate alpha i-3 from solubilized Golgi membranes; however, alpha i-3 is coprecipitated as part of the Na+ channel complex from A6 cell membranes by polyclonal Na+ channel antibodies. Both alpha i-3 and the Na+ channel have been localized in A6 cells by confocal imaging and immunofluorescence with specific antibodies and are found to be in distinct but adjacent domains of the apical cell surface. In functional studies, alpha i-3, but not alpha i-2, stimulates Na+ channel activity. These data are therefore consistent with the localization of Na+ channel activity and modulatory alpha i-3 protein at the apical plasma membrane, which together represent a specific signal transduction pathway for ion channel regulation
Severe hypertension induces disturbances of renal autoregulation
(Hypertension, 1992) Almeida, Jose Bruno de; Saragoca, Manoel A.; Tavares, Agostinho; Cezareti, Mário L.; Draibe, Sérgio A.; Ramos, Oswaldo L.
To study if the severity of hypertension could be associated with disturbances of the autoregulation of renal blood flow and glomerular filtration, we compared the renal hemodynamic and functional responses to acute blood pressure reductions of a group of patients with moderate essential hypertension (n = 10) with those of a group of patients with severe hypertension (n = 10). Blood pressure was reduced to normal levels by a stepwise infusion of sodium nitroprusside, and effective renal blood flow (by 131I-hippuran), glomerular filtration rate (by endogenous creatinine clearance), and filtration fraction were determined. After acute blood pressure normalization, effective renal blood flow and glomerular filtration rate were significantly reduced in patients with severe hypertension (-41.6 +/- 8.3% and -44.7 +/- 6.8%, respectively; p less than 0.01 for both) but not in those with moderate hypertension (+4.9 +/- 9.1% and +6.2 +/- 13.3%, respectively; NS). Filtration fraction remained unchanged in both groups. These results show that severe but not moderate essential hypertensive patients have a displacement to the right of the lower limit of the renal autoregulation curve due to impaired vasodilation to maintain adequate renal blood flow during acute reductions of blood pressure. This impairment may be due to anatomic or functional defects of preglomerular vessels, or to both. Furthermore, the inability to maintain adequate glomerular filtration in these circumstances shows that patients with severe hypertension also have an impaired ability to adjust postglomerular vasomotor tone in the face of reductions in glomerular blood flow.
Entry of cholera toxin into polarized human intestinal epithelial cells. Identification of an early brefeldin a sensitive event required for A1-peptide generation
(American Society for Clinical Investigation, 1993) Almeida, Jose Bruno de; Lencer, W. I.; Moe, S.; Stow, Jennifer L.; Ausiello, Dennis A.; Madara, J. L.
The effect of brefeldin-A (BFA), a reversible inhibitor of vesicular transport, on cholera toxin (CT)-induced Cl- secretion (Isc) was examined in the polarized human intestinal cell line, T84. Pretreatment of T84 monolayers with 5 microM BFA reversibly inhibited Isc in response to apical or basolateral addition of 120 nM CT (2.4 +/- 0.5 vs. 68 +/- 3 microA/cm2, n = 5). In contrast, BFA did not inhibit Isc responses to the cAMP agonist VIP (63 +/- 7 microA/cm2). BFA had no effect on cell surface binding and endocytosis of a functional fluorescent CT analog or on the dose dependency of CT induced 32P-NAD ribosylation of Gs alpha in vitro. In contrast, BFA completely inhibited (> 95%) the ability of T84 cells to reduce CT to the enzymatically active A1-peptide. BFA had to be added within the first 10 min of CT exposure to inhibit CT-elicited Isc. The early BFA-sensitive step occurred before a temperature-sensitive step essential for apical CT action. These studies show that sequential steps are required for a biological response to apical CT: (a) binding to cell surfaces and rapid endocytosis; (b) early, BFA-sensitive vesicular transport essential for reduction of the A1-peptide; and (c) subsequent temperature-sensitive translocation of a signal (the A1-peptide or possibly ADP-ribose-Gs alpha) to the basolateral domain
Binding of the cytosolic p200 protein to Golgi membranes is regulated by heterotrimeric G proteins
(Journal Of Cell Science, 1993) Almeida, Jose Bruno de; Doherty, Joanne; Ausiello, Dennis A.; Stow, Jennifer L.
The formation of vesicles for protein trafficking requires the dynamic binding of cytosolic coat proteins onto Golgi membranes and this binding is regulated by a variety of GTPases, including heterotrimeric G proteins. We have previously shown the presence of the pertussis toxin-sensitive G i-3 protein on Golgi membranes and demonstrated a functional role for G i-3 in the trafficking of secretory proteins through the Golgi complex. We have also described a brefeldin A-sensitive phosphoprotein, p200, which is found in the cytoplasm and on Golgi membranes. The present study investigates the role of heterotrimeric G proteins in the regulation of p200 binding to Golgi membranes. An in vitro binding assay was used to measure the binding of cytosolic p200 to LLC-PK1 cell microsomal membranes and to purified rat liver Golgi membranes in the presence of specific activators of G proteins. The binding of p200 to Golgi membranes was compared to that of the coatomer protein -COP, for which G protein-dependent membrane binding has previously been established. Membrane binding of both p200 and -COP was induced maximally by activation of all G proteins in the presence of GTP S. More selective activation of the heterotrimeric G proteins, with AlFn or mastoparan, also induced membrane binding of p200 and -COP. Pertussis toxin pretreatment of Golgi membranes, to selectively inactivate G i-3, reduced the AlFn and mastoparan-induced binding of p200 to Golgi membranes, whereas no significant effect of pertussis toxin on -COP binding was found in this assay. The effect of pertussis toxin thus implicates G i-3, as one component of a regulatory pathway, in the binding of cytosolic p200 to Golgi membranes. The effects of AlFn and pertussis toxin on p200 membrane binding were also shown in intact cells by immunofluorescence staining. AlFn treatment of cells induced translocation of p200 from the cytoplasm onto the Golgi complex, resulting in a conformational change in some Golgi membranes. The translocation of p200 was blocked by pretreatment of intact NRK cells with pertussis toxin. The data presented here support the conclusion that the binding of the p200 protein to Golgi membranes involves regulation by the pertussis toxinsensitive heterotrimeric G proteins, specifically the G i-3 protein
Distribution and role of heterotrimeric G proteins in the secretory pathway of polarized epithelial cells
(Journal Of Cell Science, 1993) Almeida, Jose Bruno de; Stow, Jennifer L.
The movement of newly synthesized proteins in the constitutive secretory pathway, from their site of synthesis in the endoplasmic reticulum to the cell surface or to intracellular destinations, requires an orderly sequence of transport steps between membrane-bound compartments. Until recently, the trafficking and secretion of proteins through this pathway was thought to occur as a relatively automatic, unregulated series of events. Recent studies show that protein trafficking in the constitutive secretory pathway requires G T P hydrolysis by families of GTP-binding proteins (G proteins), which at multiple steps potentially provide regulation and specificity for protein trafficking. M any monomeric G proteins are known to be localized and functional on membrane compartments in the constitutive secretory pathway. Now, members of the heterotrimeric G protein family have also been localized on intracellular membranes and compartments such as the Golgi complex. We have studied the localization and targeting of G a subunits to distinct membrane domains in polarized epithelial cells. The distribution of different G a subunits on very specific membrane domains in cultured epithelial cells and in epithelial cells of the kidney cortex, is highly suggestive of roles for these G proteins in intracellular trafficking pathways. One of these G protein subunits, Gai-3, was localized on Golgi membranes. Studies on L L C -P K i cells overexpressing Gcti.3 provided evidence for its functional role in regulating the transport o f a constitutively secreted heparan sulfate proteoglycan through the Golgi complex. Inhibition or activation of heterotrimeric G proteins by pertussis toxin or by aluminium fluoride respectively, have provided further evidence for regulation of intracellular transport by pertussis toxin-sensitive G proteins. Although the functions of Golgi-associated G proteins are not yet understood at the molecular level, heterotrimeric G proteins have been implicated in the binding of cytosolic coat proteins and vesicle formation on Golgi membranes. Future studies will elucidate how multiple G proteins, of both the heterotrimeric and monomeric families, are involved in the regulation of Golgi function and protein trafficking in the secretory pathway
Targeting of chimeric Gαi proteins to specific membrane domains
(Journal of Cell Science, 1994) Almeida, Jose Bruno de; Holtzman, Eliezer J.; Peters, Philip; Ercolani, Louis; Ausiello, Dennis A.; Stow, Jennifer L.
Heterotrimeric guanine nucleotide-regulatory (G) proteins are associated with a variety of intracellular membranes and specific plasma membrane domains. In polarized epithelial LLC-PK1 cells we have shown previously that endogenous Gαi-2 is localized on the basolateral plasma membrane, whereas Gαi-3 is localized on Golgi membranes. The targeting of these highly homologous Gαi proteins to distinct membrane domains was studied by the transfection and expression of chimeric Gαi proteins in LLC-PK1 cells. Chimeric cDNAs were constructed from the cDNAs for Gαi-3 and Gαi-2 and introduced into a pMXX eukaryotic expression vector containing a mouse metallothioneinI promotor. Stably transfected cell lines were produced that expressed either Gαi-2/3 or Gαi-3/2 chimeric proteins. Chimeric and endogenous Gαi proteins were detected in cells using specific carboxy-terminal peptide antibodies. Immunofluorescence staining was used to localize endogenous and chimeric Gαi proteins in LLC-PK1 cells. The staining of chimeric proteins was detected as an increased intensity of staining on membranes containing endogenous Gαi proteins. Using confocal microscopy and image analysis we localized Gαi-2 to a specific sub-domain of the lateral membrane of polarized cells, the chimeric Gαi-3/2 protein was then shown to colocalize with endognenous Gαi-2 in the same lateral plasma membrane domain. The chimeric Gαi-2/3 protein colocalized with endogenous Gαi-3 on Golgi membranes in LLC-PK1 cells. These results show that chimeric Gαi proteins were targeted to the same membrane domains as endogenous Gαi proteins and the specificity of their membrane targeting was conferred by the carboxy-terminal end of the proteins. These data provide the first evidence for specific targeting information contained in the carboxy termini of Gαi proteins, which appears to be independent of amino-terminal membrane attachment sites in these proteins
Myosin II is associated with Golgi membranes: identification of p200 as nonmuscle myosin II on Golgi-derived vesicles
(Journal Of Cell Science, 1997) Almeida, José Bruno de; Ikonen, Elina; Fath, Karl R.; Burgess, David R.; Ashman, Keith; Simons, Kai; Stow, Jennifer L.
A variety of peripheral membrane proteins associate dynamically with Golgi membranes during the budding and trafficking of transport vesicles in eukaryotic cells. A monoclonal antibody (AD7) raised against Golgi membranes recognizes a peripheral membrane protein, p200, which associates with vesicles budding off the trans-Golgi network (TGN). Based on preliminary findings, a potential association between p200 and myosin on Golgi membranes was investigated. Immunofluorescence staining of cultured cells under a variety of fixation conditions was carried out using an antibody raised against chick brush border nonmuscle myosin II. We show that, in addition to being found in the cytoplasm or associated with stress fibres, nonmuscle myosin II is also specifically localized on Golgi membranes. Myosin II was also detected on Golgi membranes by immunoblotting and by immunogold labeling at the electron microscopy level where it was found to be concentrated on Golgi-derived vesicles. The association of myosin II with Golgi membranes is dynamic and was found to be enhanced following activation of G proteins. Myosin II staining of Golgi membranes was also disrupted by brefeldin A (BFA). Colocalization of the AD7 and myosin II antibodies at the light and electron microscopy levels led us to investigate the nature of the 200 kDa protein recognized by both antibodies. The 200 kDa protein immunoprecipiated by the AD7 antibody was isolated from MDCK cells and used for microsequencing. Amino acid sequence data enabled us to identify p200 as the heavy chain of nonmuscle myosin IIA. In addition, an extra protein (240 kDa) recognized by the AD7 antibody specifically in extracts of HeLa cells, was sequenced and identified as another actin-binding protein, filamin. These results show that nonmuscle myosin II is associated with Golgi membranes and that the vesicle-associated protein p200, is itself a heavy chain of myosin II.
Gravidade da doença renal cística adquirida determina melhora da anemia da insuficiência renal crônica
(Revista da Associação Médica Brasileira, 1997) Almeida, José Bruno de; Bezerra, H.M.; Maia, G.P. M.; Bezerra Neto, F. A.; Serra, M.
OBJETIVO. Identificar correlação entre duração do tratamento dialítico, gravidade da doença renal cística adquirida (DRCA) medida pelo tamanho dos cistos e seu efeito sobre a correção espontânea da anemia. MATERIAL E MÉTODOS. Foram selecionados dez pacientes, seis do sexo masculino e quatro do feminino, com mais de cinco anos em tratamento dialítico. Nenhum paciente selecionado tinha doença renal policística bilateral como doença primária. A avaliação renal foi feita com ultra-sonografia. DRCA foi caracterizada pela presença de quatro ou mais cistos em cada rim. Os maiores cistos foram medidos para efeito de correlação. O diagnóstico da anemia foi estabelecido pelo valor do hematócrito e da hemoglobina séricos. Foram analisados, também, uréia, creatinina, albumina, ferro, capacidade total de combinação do ferro e o percentual de saturação da transferrina séricos. RESULTADOS. Os pacientes estavam adequadamente dialisados (uréia e creatinina séricas = 98,7 ± 35mg/dL e 9,7 ± 2,7mg/dL, respectivamente), com bom estado nutricional (albumina sérica = 4,5 ± 0,5g/dL), e tinham razoável reserva de ferro (ferro sérico = 80 ± 34mg/dL). A prevalência de DRCA foi de 80%. Não detectamos nenhum sinal ultra-sonográfico de malignidade nesses cistos. Houve correlação significante entre tempo de diálise e hematócrito (R = 0,70; p < 0,05). O tamanho dos cistos teve correlação direta e significante com os valores do hematócrito (R = 0,74; p < 0,05). CONCLUSÕES. Os resultados mostram que a melhora espontânea da anemia observada nos pacientes em diálise crônica se correlaciona de forma significante com a gravidade da doença renal cística adquirida. Isso sugere uma atividade funcional dos cistos renais na produção de eritropoetina
Hipertensão arterial: hipertensão arterial e a progressão da lesão renal. Em que podemos intervir?
(Jornal Brasileiro de Nefrologia, 1998) Almeida, José Bruno de
Em 1993, cerca de 250.000 pacientes foram tratados para insuficiência renal crônica nos Estados Unidos. Diabetes mellitus (35%), hipertensão arterial (29%) e glomerulonefrite crônica (11%) foram as causas mais comuns da doença renal crônica. Houve um custo anual estimado da ordem de 11 bilhões de dólares. Por esta razão, um dos principais objetivos da nefrologia atual é a redução da incidência de insuficiência renal crônica através da prevenção das nefropatias (prevenção primária) ou retandando a progressão da lesão renal estabelecida (prevenção secundária). 2 A evolução natural da doença renal crônica, independente da etiologia, geralmente é progressivo e culmina com estágio terminal de insuficiência renal crônica e indicação de diálise e/ou transplante renal. Algumas medidas têm sido preconizadas para retardar a progressão da lesão renal, tais como diminuição da ingesta de proteínas, redução da pressão arterial, da excreção urinária de proteínas e dos níveis das lipoproteínas plasmáticas. 3 A proposta desta atualização é revisar os dados da literatura atual sobre a importância do controle da pressão arterial na progressão da lesão renal correlacionando os aspectos fisiopatológicos com as mais recentes evidências clínicas
Influência do corticóide na cicatrização da anastomose traqueal sob tensão em cães
(Acta Cirúrgica Brasileira, 2003) Araújo, Carlos Alberto Almeida de; Aguiar, José Lamartine de Andrade; Lima, Francisco Pignataro; Azevêdo, Ítalo Medeiros de; Medeiros, Aldo da Cunha
OBJETIVO: Trabalho com o objetivo de analisar a freqüência e intensidade de estenose traqueal após ressecção e anastomose sob tensão; ação da metilprednisolona como agente profilático da estenose traqueal e a caracterização dos fenômenos da cicatrização com e sem o uso de corticóide. MÉTODOS: Foram utilidados 20 cães mestiços pesando 13± 5 Kg divididos aleatoriamente em dois grupos. No grupo A(n=10) não foi usado corticóide (controle). No grupo B foi usada a metilprednisolona IM na dose 10mg/Kg. Sob anestesia geral com intubação orotraqueal foram ressecados 3 anéis traqueais de todos animais, de modo que a força para aproximação das extremidades da traquéia foi uniformemente de 300gf. Após 30 dias de observação os animais foram tratados com dose letal de anestésico e KCl, quando foi ressecada a traquéia para medida dos diâmetros internos da anastomose e da traquéia normal, com auxílio de paquímetro digital. Na análise histopatológica com as colorações HE e tricrômico de Masson utilizou-se sistema digitalizado para quantificar as estruturas dos tecidos em cicatrização. RESULTADOS: Foi observado maior índice de estenose da traquéia no grupo A que não utilizou corticóide, do que no grupo B, com diferença significante (p<0,01). A reação inflamatória, formação de fibras colágenas e de fibroblastos ocorreu com densidade média mais intensa no grupo A, caracterizando uma diferença significante (p<0,01). CONCLUSÃO: Os dados permitem concluir que o uso da metilprednisolona em cães submetidos a ressecção de traquéia e anastomose sob tensão contribuiu para diminuir a intensidade e frequência da estenose na zona da anastomose e fez reduzir a reação inflamatória nos tecidos em cicatrização.
Eletroneuromiografia: estimativa do número de unidades motoras na ELA
(Revista Neurociências, 2006) Dourado Junior, Mário Emílio Teixeira; https://orcid.org/0000-0002-9462-2294
Passados 132 anos da descrição do quadro clínico da Esclerose Lateral Amiotrófica (ELA) por Charcot infelizmente a história natural desta enfermidade não se modificou. É a degeneração dos neurônios motores, cerebral e espinhal, responsável pelos principais sinais e sintomas da doença, que leva a perda progressiva da função e ao óbito, em média, cinco anos após o diagnóstico. Nos últimos anos, entretanto, houve um grande avanço no entendimento desta enfermidade, tornando-se um exemplo de doença neurodegenerativa como modelo para testes terapêuticos.
Effect of end-stage renal disease and diabetes on zinc and copper status
(Springer, 2006) Almeida, José Bruno de; Batista, Maria Nazaré; Cuppari, Lílian; Pedrosa, Lucia de Fátima Campos; Almeida, Maria das Graças; Medeiros, Anna Cecília Queiroz de; Canziani, Maria Eugiènia F.
The aim of this study was to compare the nutritional status of zinc and copper in patients with and without diabetes submitted to chronic hemodialysis. Thirty-three patients with type 2 diabetes (DM group), 30 nondiabetic patients (NDM group), and 20 healthy individuals (control group) were studied. Plasma, erythrocyte, and urinary zinc and plasma copper were obtained from atomic absorption spectrophotometry and ceruloplasmin by immunonephelometry. The anthropometric parameters were similar among the groups. Plasma zinc was lower and erythrocyte zinc was higher in the DM and NDM groups in relation to the control group. No difference in urinary zinc was observed comparing the groups. Plasma copper was higher in the DM group when compared to the NDM and control groups. Ceruloplasmin was similar in the three groups. Serum urea was a positive independent determinant of plasma zinc concentrations. The determinants of erythrocyte zinc were MAMC midarm nuscle circumference and Kt/V dialysis adequacy. The determinants of plasma copper concentration were serum creatinine and serum glucose. The results of this study demonstrate an alteration in the distribution of zinc of patients with chronic kidney disease (CKD) independently of the presence of DM. Also, the status of copper seems not to be influenced by CKD, but only by the metabolic derangements associated with diabetes.
Frequency of stroke types at an emergency hospital in Natal, Brazil
(Arquivos de Neuro-Psiquiatria, 2007) Dourado Junior, Mário Emílio Teixeira; Martins Junior, Antonio N.N.; Figueiredo, Marcelo Marinho de; Rocha, Orlandil D.; Ferreira, Maria Angela Fernandes; Jeronimo, Selma Maria Bezerra; https://orcid.org/0000-0002-9462-2294
Realizamos um estudo de prevalência para determinar a freqüência dos tipos de acidente vascular cerebral (AVC) num hospital de urgência de Natal. Estudaram-se todos os pacientes que foram admitidos no hospital de urgência com diagnóstico presuntivo de AVC. Dos 416 pacientes, 328 foram estudados, 88 foram excluídos por não cumprirem os critérios de inclusão, 74,7% (n= 245) tiveram AVC isquêmico, 17,7% (n=58) hemorragia intracerebral e 7,6% (n=25) hemorragia subaracnóidea. O gênero mais prevalente foi o masculino (52,7%). A média de idade foi 64,1 anos. A letalidade intra-hospitalar foi de 10,2%, 17,2% e 36% para o tipo isquêmico, hemorrágico e hemorragia subaracnóide, respectivamente. O principal fator de risco modificável foi a hipertensão arterial sistêmica (HAS) para AVC isquêmico (67,6%) e AVC hemorrágico (57,8%). A regressão logística identificou diabetes como fator de risco independente para AVC isquêmico (OR=3,70; IC=1,76-7,77). O AVC isquêmico foi o tipo mais comum. HAS e diabetes foram importantes fatores de risco
Oxalose primária diagnosticada após transplante renal - relato de caso
(Brazilian Journal of Transplantation, 2007) Almeida, José Bruno de; Costa, Kellen Micheline Alves Henrique; Quinino, Raquel Martins e; Moura, Luiz Antônio Ribeiro de; Félix, Ricardo Humberto de Miranda; Bandeira, Rodrigo de Lima; Silva Júnior, Maurício Ferreira da
Relata-se um caso provável de hiperoxalúria primária tipo 1 em uma paciente jovem cujo diagnóstico foi realizado apenas após o transplante renal. O objetivo deste trabalho é chamar atenção para uma enfermidade rara de diagnóstico difícil, principalmente quando se trata de paciente em terapia renal substitutiva. Trata-se de uma adolescente de 16 anos em hemodiálise, que se submeteu a transplante renal com doador vivo relacionado (mãe), inicialmente com boa resposta do enxerto, chegando a apresentar creatinina de 1,2mg/dl no 2º dia pós- operatório (DPO), porém com piora progressiva e rápida da função renal no 4º DPO. Realizou-se biópsia renal e a oxalose primária foi diagnosticada. Apesar do tratamento instituído com Piridoxina e diálise diária, houve perda do enxerto. O tratamento definitivo da doença consiste no transplante hepatorrenal, devendo este ser realizado o mais precocemente possível. O conhecimento dessa enfermidade por parte dos nefrologistas é relevante, uma vez que a paciente poderia ter sido mais bem preparada para o transplante renal, se tivesse chegado ao ambulatório com esse diagnóstico.
Superior mesenteric artery syndrome after laparoscopic sleeve gastrectomy
(Springer, 2007-06-13) Quinino, Reynaldo Martins e; Inácio Neto, Nelson; Godoy, Eudes Paiva; Campos, Josemberg Marins; Abrantes, Thiago; Barbosa, André Luis; Fonseca, Carlos Alexandre Guerra; https://orcid.org/0000-0002-4284-2543
Superior mesenteric artery syndrome is a duodenal obstructive complication, which has been reported after Roux-en-Y gastric bypass. We report a patient who presented a fistula at the angle of His after a laparoscopic sleeve gastrectomy, which was treated with endoscopic procedures and laparoscopic drainage. During this period, there was excessive, rapid weight loss to BMI 22 kg/m2. At 3 months after the fistula had closed, metrorrhagia was treated by blood transfusion and urgent hysterectomy. Following this, diarrhea occurred and worsened the malnutrition, and the BMI was 18. Duodenal obstruction occurred, confirmed by radiological studies and endoscopy. Duodenojejunostomy and choleystectomy were done, and there has been no recurrence of duodenal obstruction in the 14 follow-up months.
Airflow limitation in brazilian caucasians: FEV1 /FEV6 vs. FEV1 /FVC
(Jornal Brasileiro de Pneumologia, 2008-06) Soares, André Luis Pinto; Rodrigues, Sílvia Carla Sousa; Pereira, Carlos Alberto de Castro
Objective: To evaluate the use of the forced expiratory volume in one second/forced expiratory volume in six seconds (FEV1 /FEV6 ) ratio as an alternative to the FEV1 /forced vital capacity (FVC) ratio in the detection of mild airway obstruction. Methods: Reference equations for the Brazilian population in 2006 were used in order to determine the lower limits of normality for the FEV1 /FEV6 and FEV1 /FVC ratios. The spirometry findings of 155 patients from 20 to 84 years of age were analyzed. All of the patients presented the following: a < 15% difference between predicted and observed FEV1 /FVC ratio; an FEV1 ≥ 60% of predicted; and an exhalation time of at least 6 s. The Brazilian Thoracic Society criteria for acceptability and reproducibility in spirometry were met. Results: Mean values (± SD) for FEV1 /FEV6 and FEV1 /FVC were 73 ± 4% and 75 ± 3%, respectively. Using the FEV1 /FVC ratio, we identified airflow obstruction in 61 patients, compared with only 46 patients when we used the FEV1 /FEV6 ratio, showing a sensitivity of 75% (p < 0.001). Conclusions: The FEV1 /FEV6 ratio has poor sensitivity and should not be used to replace the FEV1 /FVC ratio in the diagnosis of mild airway obstruction.
The pubovesical complex-sparing technique on laparoscopic radical prostatectomy
(International Braz J Urol, 2008-07) Rebouças, Rafael Batista; Monteiro, Rodrigo Campos; Lima, João Paulo Pereira; Almeida, Filipe de Pádua B. F.; Britto, Cesar Araujo; Machado, Marcos Tobias; Passerotti, Carlo
Introduction: Preservation of urinary continence is a great challenge in Radical Prostatectomy. In order to improve functional results, Asimakopoulos et al. (2010) described a robot-assisted surgical technique with preservation of the pubovesical complex (PVC). We present a pure laparoscopic execution. Presentation: A 61-year-old male patient with a diagnosis of prostate cancer, with PSA 6.54ng/ml, DRE: T1C and Gleason 6 (3+3) 1/12 fragments. All therapeutic possibilities were discussed, including active surveillance. The patient opted for surgical treatment. A transperitoneal technique was used. We started the dissection on the left side, in the limit between the detrusor and the base of the prostate. The left seminal vesicle was dissected and left neurovascular bundle released by a high anterior dissection. We repeated the same procedure on the right side. The urethra was then divided, prostatic apex was laterally drawn and PVC was released. The bladder neck was divided and an urethrovesical anastomosis was achieved. A pelvic drain was placed. Results: The total operative time was 150 minutes. The estimated blood loss was 300mL. The drain was removed on the 1st postoperative day and the patient was discharged. The Foley catheter was removed after 7 days and the patient remained completely dry. Hystopathology revealed adenocarcinoma Gleason 6, negative margins. PSA after 30 days was <0.04ng/mL, and the patient reported partial penile erection. Conclusion: The Pubovesical Complex-Sparing Technique on Laparoscopic Radical Prostatectomy was feasible and safe. Further adequately designed studies are needed to confirm whether this technique enhances early functional outcomes.
Trauma raquimedular craniocervical: revisão da literatura
(Thieme Gruppe, 2008-12) Botelho, Ricardo Vieira; Marcelo Duva, Borgheresi; Batista, André Lima
Objetivo: Revisão da literatura sobre o trauma craniocervical. Métodos: Com base em revisão eletrônica da literatura nos dados da PubMed, em revisões sistemáticas e em diretrizes internacionais na língua inglesa. A revisão abrangeu os temas “deslocamento atlanto-occipital”, “fraturas do côndilo occipital”, “fraturas do atlas”, “lesões do ligamento transverso”, “instabilidade vertical atlantoaxial traumática” e “fraturas do áxis”. Resultado: A avaliação da literatura utilizando-se de técnicas de análise da qualidade da publicação, eliminando vícios e tendenciosidades de interpretação, permitindo a comparação matemática de resultados, propiciou o surgimento de conclusões menos discutíveis da eficiência dos vários métodos de tratamento.
Hiperhidrose compensatória após simpatectomia toracoscópica: características, prevalência e influência na satisfação do paciente
(Jornal Brasileiro de Pneumologia, 2009) Araújo, Carlos Alberto Almeida de; Azevedo, Ítalo Medeiros; Ferreira, Maria Angela Fernandes; Ferreira, Hylas Paiva da Costa; Dantas, Jorge Lúcio Costa de Medeiros; Medeiros, Aldo Cunha
Objetivo: Trabalho com o objetivo de analisar a freqüência e intensidade de estenose traqueal após ressecção e anastomose sob tensão; ação da metilprednisolona como agente profilático da estenose traqueal e a caracterização dos fenômenos da cicatrização com e sem o uso de corticóide. Métodos: Foram utilidados 20 cães mestiços pesando 13±5 Kg divididos aleatoriamente em dois grupos. No grupo A(n=10) não foi usado corticóide (controle). No grupo B foi usada a metilprednisolona IM na dose 10mg/Kg. Sob anestesia geral com intubação orotraqueal foram ressecados 3 anéis traqueais de todos animais, de modo que a força para aproximação das extremidades da traquéia foi uniformemente de 300gf. Após 30 dias de observação os animais foram tratados com dose letal de anestésico e KCl, quando foi ressecada a traquéia para medida dos diâmetros internos da anastomose e da traquéia normal, com auxílio de paquímetro digital. Na análise histopatológica com as colorações HE e tricrômico de Masson utilizou-se sistema digitalizado para quantificar as estruturas dos tecidos em cicatrização. Resultados: Foi observado maior índice de estenose da traquéia no grupo A que não utilizou corticóide, do que no grupo B, com diferença significante (p<0,01). A reação inflamatória, formação de fibras colágenas e de fibroblastos ocorreu com densidade média mais intensa no grupo A, caracterizando uma diferença significante (p<0,01). Conclusão: Os dados permitem concluir que o uso da metilprednisolona em cães submetidos a ressecção de traquéia e anastomose sob tensão contribuiu para diminuir a intensidade e frequência da estenose na zona da anastomose e fez reduzir a reação inflamatória nos tecidos em cicatrização.

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