Actitud expectante en el síndrome del cascanueces

Nutcracker syndrome is caused by compression of the left renal vein between the aorta and the superior mesenteric artery where it passes in the fork formed at the bifurcation of these arteries. The phenomenon results in left renal venous hypertension. The syndrome is manifested by left flank and abdominal pain, with or without unilateral haematuria. The nutcracker syndrome has been treated in various ways. We report one case of the syndrome and discuss the place of surveillance in its management.     

Adaptation of the distal convoluted tubule of the rat. Structural and functional effects of dietary salt intake and chronic diuretic infusion.

We studied the effects of dietary NaCl intake on the renal distal tubule by feeding rats high or low NaCl chow or by chronically infusing furosemide. Furosemide-treated animals were offered saline as drinking fluid to replace urinary losses. Effects of naCl intake were evaluated using free-flow micropuncture, in vivo microperfusion, and morphometric techniques. Dietary NaCl restriction did not affect NaCl delivery to the early distal tubule but markedly increased the capacity of the distal convoluted tubule to transport Na and Cl. Chronic furosemide infusion increased NaCl delivery to the early distal tubule and also increased the rates of Na and Cl transport above the rates observed in low NaCl diet rats. When compared with high NaCl intake alone, chronic furosemide infusion with saline ingestion increased the fractional volume of distal convoluted tubule cells by nearly 100%, whereas dietary NaCl restriction had no effect. The results are consistent with the hypotheses that (a) chronic NaCl restriction increases the transport ability of the distal convoluted tubule independent of changes in tubule structure, (b) high rates of ion delivery to the distal nephron cause tubule hypertrophy, and (c) tubule hypertrophy is associated with increases in ion transport capacity. They indicate that the distal tubule adapts functionally and structurally to perturbations in dietary Na and Cl intake.     

Immunological response to mistletoe (Viscum album L.) in cancer patients: a four‐case series

European mistletoe (Viscum album) has been used in complementary cancer treatment, but little is known concerning its effects on immunological parameters, although there is evidence that Viscum may stimulate the immune system. In this study, a trial was conducted with cancer patients to determine whether Viscum album extracts could improve the results of immune tests. These were: white blood cell count (leukocytes, neutrophils, lymphocytes), CD4+ and CD8+ T‐lymphocytes, intradermal tests of delayed hypersensitivity (candidin, trichophytin, purified protein derivative‐PPD), complement C3 and C4, and immunoglobulin A, G and M. Four patients received seven doses of subcutaneous Viscum album 20 mg, twice weekly. Immunological tests were carried out before and after treatment, and an increase in several parameters of humoral and cellular immunity were shown. Apart from reactions around the injection sites, treatment was well tolerated and all patients benefited from it. These results suggest that Viscum album can enhance humoral and cellular immune responses in cancer patients, but further studies attesting to the possible clinical impact of these immunological effects are necessary. Copyright © 2008 John Wiley & Sons, Ltd.     

Treatment of the Breast’s Lateral Pole: Adjuvant Maneuver to Pitanguy’s Technique

Surgical procedures for the mammary region currently are assuming an important role in body-contouring surgery. Enhancement of results is a constant challenge to the plastic surgeon. A simple and efficient maneuver for resection of the breast’s lateral pole based on the mammoplasty technique of Professor Ivo Pitanguy is described. This study realized at the Private Clinic Sérgio Carreir?o, Rio de Janeiro, RJ, Brazil.