Effects of crude protein and non-essential amino acids on growth performance, blood profile, and intestinal health of weaned piglets

This study investigated the effect of crude protein (CP) and non-essential amino acid (NEAA) supplementation on the growth performance, blood profile, intestinal morphology, mRNA relative abundance of inflammatory and antioxidant markers, and tight junction proteins in piglets over the first 2 weeks after weaning. Ninety 21-day-old piglets (7.55 ± 0.72 kg) were assigned in a randomized block design to one of three dietary treatments: (1) high CP, a diet with 24% CP; (2) low CP, a diet with 18% CP; and (3) low CP + NEAA, a diet with 18% CP supplemented with 5 g/kg Arg (L-arginine; purity >99%) and 10 g/kg Glu + Gln (minimum 10% L-glutamine and minimum 10% L-glutamate). Piglets were fed with corn-soybean meal basal diets in a 14-day trial. There was an improvement (p < 0.05) in the feed conversion ratio of piglets fed the high-CP diet compared to treatments with low CP or low CP + NEAA. Serum urea nitrogen was higher (p < 0.05) in piglets fed high CP compared to other dietary treatments. In the duodenum, the villus height of animals fed the low-CP + NEAA diets was greater (p < 0.05) than those fed with the high- and low-CP diets. The goblet cell proportion of piglets fed low CP + NEAA or high CP was higher (p < 0.05) compared to low CP. In the jejunum, the crypt depth of the piglets with the high-CP dietary treatment was greater (p < 0.05) in comparison with low CP + NEAA. In the jejunum, IFN-γ mRNA expression was higher (p < 0.05) in animals fed the high-CP diets compared to other dietary treatments. However, superoxide dismutase and occludin mRNA expression were higher (p < 0.05) in animals fed low CP + NEAA than in piglets on the high-CP diets. In the ileum, the number of Peyer's patches in piglets fed high CP was higher (p < 0.05) compared to other dietary treatments. In conclusion, the high-CP diet (24% CP) improves the feed conversion of piglets in the first 2 weeks after weaning compared to the low-CP diet (18% CP) supplemented or not with NEAA. However, the low-CP diet supplemented with NEAA (Arg, Gln, and Glu) improves intestinal health in piglets by promoting greater villus height and proportion of goblet cells in the duodenum, reducing jejunal crypt depth, and reducing Peyer's number patches in the ileum. In addition, piglets that received the low-CP + NEAA diet showed an increase in superoxide dismutase and occludin and a lower expression of IFN-γ mRNA.

Textbook outcome following oesophagectomy for cancer: international cohort study

Background

Textbook outcome has been proposed as a tool for the assessment of oncological surgical care. However, an international assessment in patients undergoing oesophagectomy for oesophageal cancer has not been reported. This study aimed to assess textbook outcome in an international setting.

Methods

Patients undergoing curative resection for oesophageal cancer were identified from the international Oesophagogastric Anastomosis Audit (OGAA) from April 2018 to December 2018. Textbook outcome was defined as the percentage of patients who underwent a complete tumour resection with at least 15 lymph nodes in the resected specimen and an uneventful postoperative course, without hospital readmission. A multivariable binary logistic regression model was used to identify factors independently associated with textbook outcome, and results are presented as odds ratio (OR) and 95 per cent confidence intervals (95 per cent c.i.).

Results

Of 2159 patients with oesophageal cancer, 39.7 per cent achieved a textbook outcome. The outcome parameter ‘no major postoperative complication’ had the greatest negative impact on a textbook outcome for patients with oesophageal cancer, compared to other textbook outcome parameters. Multivariable analysis identified male gender and increasing Charlson comorbidity index with a significantly lower likelihood of textbook outcome. Presence of 24-hour on-call rota for oesophageal surgeons (OR 2.05, 95 per cent c.i. 1.30 to 3.22; P = 0.002) and radiology (OR 1.54, 95 per cent c.i. 1.05 to 2.24; P = 0.027), total minimally invasive oesophagectomies (OR 1.63, 95 per cent c.i. 1.27 to 2.08; P &lt; 0.001), and chest anastomosis above azygous (OR 2.17, 95 per cent c.i. 1.58 to 2.98; P &lt; 0.001) were independently associated with a significantly increased likelihood of textbook outcome.

Conclusion

Textbook outcome is achieved in less than 40 per cent of patients having oesophagectomy for cancer. Improvements in centralization, hospital resources, access to minimal access surgery, and adoption of newer techniques for improving lymph node yield could improve textbook outcome.

Textbook outcome following oesophagectomy for cancer: international cohort study

BACKGROUND

Textbook outcome has been proposed as a tool for the assessment of oncological surgical care. However, an international assessment in patients undergoing oesophagectomy for oesophageal cancer has not been reported. This study aimed to assess textbook outcome in an international setting.

METHODS

Patients undergoing curative resection for oesophageal cancer were identified from the international Oesophagogastric Anastomosis Audit (OGAA) from April 2018 to December 2018. Textbook outcome was defined as the percentage of patients who underwent a complete tumour resection with at least 15 lymph nodes in the resected specimen and an uneventful postoperative course, without hospital readmission. A multivariable binary logistic regression model was used to identify factors independently associated with textbook outcome, and results are presented as odds ratio (OR) and 95 per cent confidence intervals (95 per cent c.i.).

RESULTS

Of 2159 patients with oesophageal cancer, 39.7 per cent achieved a textbook outcome. The outcome parameter 'no major postoperative complication' had the greatest negative impact on a textbook outcome for patients with oesophageal cancer, compared to other textbook outcome parameters. Multivariable analysis identified male gender and increasing Charlson comorbidity index with a significantly lower likelihood of textbook outcome. Presence of 24-hour on-call rota for oesophageal surgeons (OR 2.05, 95 per cent c.i. 1.30 to 3.22; P = 0.002) and radiology (OR 1.54, 95 per cent c.i. 1.05 to 2.24; P = 0.027), total minimally invasive oesophagectomies (OR 1.63, 95 per cent c.i. 1.27 to 2.08; P < 0.001), and chest anastomosis above azygous (OR 2.17, 95 per cent c.i. 1.58 to 2.98; P < 0.001) were independently associated with a significantly increased likelihood of textbook outcome.

CONCLUSION

Textbook outcome is achieved in less than 40 per cent of patients having oesophagectomy for cancer. Improvements in centralization, hospital resources, access to minimal access surgery, and adoption of newer techniques for improving lymph node yield could improve textbook outcome.

Postoperative outcomes in oesophagectomy with trainee involvement

BACKGROUND

The complexity of oesophageal surgery and the significant risk of morbidity necessitates that oesophagectomy is predominantly performed by a consultant surgeon, or a senior trainee under their supervision. The aim of this study was to determine the impact of trainee involvement in oesophagectomy on postoperative outcomes in an international multicentre setting.

METHODS

Data from the multicentre Oesophago-Gastric Anastomosis Study Group (OGAA) cohort study were analysed, which comprised prospectively collected data from patients undergoing oesophagectomy for oesophageal cancer between April 2018 and December 2018. Procedures were grouped by the level of trainee involvement, and univariable and multivariable analyses were performed to compare patient outcomes across groups.

RESULTS

Of 2232 oesophagectomies from 137 centres in 41 countries, trainees were involved in 29.1 per cent of them (n = 650), performing only the abdominal phase in 230, only the chest and/or neck phases in 130, and all phases in 315 procedures. For procedures with a chest anastomosis, those with trainee involvement had similar 90-day mortality, complication and reoperation rates to consultant-performed oesophagectomies (P = 0.451, P = 0.318, and P = 0.382, respectively), while anastomotic leak rates were significantly lower in the trainee groups (P = 0.030). Procedures with a neck anastomosis had equivalent complication, anastomotic leak, and reoperation rates (P = 0.150, P = 0.430, and P = 0.632, respectively) in trainee-involved versus consultant-performed oesophagectomies, with significantly lower 90-day mortality in the trainee groups (P = 0.005).

CONCLUSION

Trainee involvement was not found to be associated with significantly inferior postoperative outcomes for selected patients undergoing oesophagectomy. The results support continued supervised trainee involvement in oesophageal cancer surgery.

TB management in the European Union/European Economic Area: a multi-centre survey

BACKGROUND:

Essential TB care in the European Union/European Economic Area (EU/EEA) comprises 21 standards for the diagnosis, treatment and prevention of TB that constitute the European Union Standards for Tuberculosis Care (ESTC).

METHODS:

In 2017, we conducted an audit on TB management and infection control measures against the ESTC standards. TB reference centres in five EU/EEA countries were purposely selected to represent the heterogeneous European TB burden and examine geographic variability.

RESULTS:

Data from 122 patients, diagnosed between 2012 and 2015 with multidrug-resistant TB (n = 49), extensively drug-resistant TB (XDR-TB) (n = 11), pre-XDR-TB (n = 29) and drug-susceptible TB (n = 33), showed that TB diagnosis and treatment practices were in general in agreement with the ESTC.

CONCLUSION:

Overall, TB management and infection control practices were in agreement with the ESTC in the selected EU/EEA reference centres. Areas for improvement include strengthening of integrated care services and further implementation of patient-centred approaches.

Comparison of short-term outcomes from the International Oesophago-Gastric Anastomosis Audit (OGAA), the Esophagectomy Complications Consensus Group (ECCG), and the Dutch Upper Gastrointestinal Cancer Audit (DUCA)

BACKGROUND

The Esophagectomy Complications Consensus Group (ECCG) and the Dutch Upper Gastrointestinal Cancer Audit (DUCA) have set standards in reporting outcomes after oesophagectomy. Reporting outcomes from selected high-volume centres or centralized national cancer programmes may not, however, be reflective of the true global prevalence of complications. This study aimed to compare complication rates after oesophagectomy from these existing sources with those of an unselected international cohort from the Oesophago-Gastric Anastomosis Audit (OGAA).

METHODS

The OGAA was a prospective multicentre cohort study coordinated by the West Midlands Research Collaborative, and included patients undergoing oesophagectomy for oesophageal cancer between April and December 2018, with 90 days of follow-up.

RESULTS

The OGAA study included 2247 oesophagectomies across 137 hospitals in 41 countries. Comparisons with the ECCG and DUCA found differences in baseline demographics between the three cohorts, including age, ASA grade, and rates of chronic pulmonary disease. The OGAA had the lowest rates of neoadjuvant treatment (OGAA 75.1 per cent, ECCG 78.9 per cent, DUCA 93.5 per cent; P < 0.001). DUCA exhibited the highest rates of minimally invasive surgery (OGAA 57.2 per cent, ECCG 47.9 per cent, DUCA 85.8 per cent; P < 0.001). Overall complication rates were similar in the three cohorts (OGAA 63.6 per cent, ECCG 59.0 per cent, DUCA 62.2 per cent), with no statistically significant difference in Clavien-Dindo grades (P = 0.752). However, a significant difference in 30-day mortality was observed, with DUCA reporting the lowest rate (OGAA 3.2 per cent, ECCG 2.4 per cent, DUCA 1.7 per cent; P = 0.013).

CONCLUSION

Despite differences in rates of co-morbidities, oncological treatment strategies, and access to minimal-access surgery, overall complication rates were similar in the three cohorts.

Completeness of TB notification in Portugal, 2015: an inventory and capture-recapture study

BACKGROUND: Despite the steady decline in the last few decades, Portugal remains the Western European country with the highest TB notification rates. The aim of this study was to estimate the completeness of notification to the National Tuberculosis Programme (NTP) Surveillance System (SVIG-TB) in 2015.METHODS: We implemented an inventory study and a three-source log-linear capture-recapture analysis using two additional data sources that were deterministic and probabilistically linked: the national notifiable diseases surveillance system (Sistema Nacional de Vigilância Epidemiológica SINAVE) and the national hospital discharge database (Grupos de Diagnósticos Homogéneos GDH).RESULTS: We identified 2328 unique probable/confirmed TB cases across the three data sources. We found a positive dependency between SVIG-TB and SINAVE (incidence rate ratio IRR 8.9, 95%CI 6.6-12.0) and between GDH and SINAVE (IRR 2.6, 95%CI 2.0-3.4). After adjusting for these dependencies, we estimated that 266 cases (95%CI 198-358) were not reported, indicating a notification (to SVIG-TB) completeness rate of 77.0%.CONCLUSION: True incidence rate of TB in Portugal in 2015 could have been as high as 26.1 per 100 000. This could be an overestimation because of false-positive cases recorded in both SINAVE and GDH or on a smaller scale, false non-matches. Studies aimed at validating potentially false-positive cases should be implemented to address these limitations.

Ecophysiological traits of highly mobile large marine predators inferred from nucleic acid derived indices

Nucleic acid-derived indices such as RNA/DNA ratios have been successfully applied as ecophysiological indicators to assess growth, nutritional condition and health status in marine organisms given that they provide a measure of tissue protein reserves, which is known to vary depending on changes in the environment. Yet, the use of these biochemical indices on highly mobile large predators is scarce. In this study, we tested the applicability of using nucleic acids to provide insights on the ecophysiological traits of two marine mammal species (common bottlenose dolphins and short-finned pilot whales) and explored potential related factors (species, sex, season, and residency pattern), using skin tissue (obtained from biopsy darts) of apparently healthy and adult free-ranging animals. Significantly higher RNA/DNA ratios were obtained for bottlenose dolphins (p < 0.001), and for visitor pilot whales when compared with resident pilot whales (p = 0.001). No significant changes were found between the sexes. Based on the percentile approach, the samples contain individuals in a general good condition (as the 10^th percentile is not closer to the mean than the 75^th percentile), suggesting that the studied region of Macaronesia may be considered an adequate habitat. The combination of this effective tool with genetic sexing and photographic-identification provided an overall picture of ecosystem health, and although with some limitations and still being a first approach, it has the applicability to be used in other top predators and ecosystems.

Pandemic influenza A (H1N1) in the North of Portugal: how did the autumn-winter wave behave?

INTRODUCTION

In April 2009 the Centers for Disease Control and Prevention announced the identification of a novel influenza virus in two patients in California, called influenza A (H1N1) 2009. On 11 June 2009 the Director-General of the World Health Organization declared a pandemic of influenza A (H1N1). In Portugal the first case of pandemic influenza A (H1N1) was reported on 29th April and the Northern Region of the country registered the first cases soon after that.

AIM

This report pretends to give an overview of the characteristics of Autumn/Winter pandemic wave in the North of Portugal.

RESULTS

A total of 64 195 cases of influenza-like illness were registered in public health services in the region between week 40, 2009 and week 4, 2010. The cumulative attack rate of those cases was 17.1/1 000 inhabitants. Most of the cases occurred in females and in the under 20 years. The peak of the Autumn/Winter wave was attained in week 48, but geographic and time distribution of the pandemic was heterogeneous in the region. Hospitalization rate for influenza-like illness cases in the population was higher for the under 10 years and decreased with age. Forty four deaths in pandemic influenza A (H1N1) laboratory-confirmed cases occurred in the region (mortality rate - 1.2/100 000) and the risk of death was lower in younger age groups. The peak of deaths occurred two weeks later than the peak of cases.

CONCLUSION

We can assume that the Autumn/Winter pandemic wave impact was mild in the Northern Region of Portugal. We consider the importance of pursuing and reinforcing influenza surveillance in the region.

Community-acquired pneumonia and influenza hospitalisations in northern Portugal, 2000-2005

Binary file ES_Abstracts_Final_ECDC.txt matches

Reply to Letter: Outbreaks caused by parvovirus B19

We are grateful for the comments provided by Kelly and Leydon, and Bernard J Cohen. They seem to share our previously expressed opinion that ’in the context of measles and rubella elimination programs, study protocols should include data collection procedures and laboratory tests able to confirm or discard the diagnosis of B19 infections.’ [1]. They have provided a useful commentary with relevant information and references.

Outbreaks caused by parvovirus B19 in three Portuguese schools

This paper reports the study of outbreaks of an acute exanthematous disease among children of three schools in the municipality of Braga (Portugal). Laboratory tests were performed for five cases, showing that the disease was not due to infection by measles or rubella virus, and infection with parvovirus B19 was confirmed. There were 41 cases in children: 12 in the kindergarten, 17 in the secondary school and 12 in the primary school. There was only one case in a staff member, who worked in the kindergarten. Eight cases were identified among household contacts; two of them were brothers, one from the kindergarten and another from the secondary school, where the outbreak occurred after the kindergarten outbreak. The estimated values of the basic reproduction number R0 were very low and it is very likely that asymptomatic infectious cases have occurred. The local health authority produced written documents and met with staff members and parents. Primary healthcare facilities and the obstetric department of the local hospital were also informed. As we are approaching the elimination of measles in Portugal and the rest of Europe, with very high vaccine coverage, it is very likely that a high proportion of infectious non-vesicular exanthemas will be due to B19 infections. This is to be taken into account in the design and conduct of surveillance activities, in the context of measles and rubella elimination programmes.

Outbreaks caused by parvovirus B19 in three Portuguese schools

This paper reports the study of outbreaks of an acute exanthematous disease among children of three schools in the municipality of Braga (Portugal). Laboratory tests were performed for five cases, showing that the disease was not due to infection by measles or rubella virus, and infection with parvovirus B19 was confirmed. There were 41 cases in children: 12 in the kindergarten, 17 in the secondary school and 12 in the primary school. There was only one case in a staff member, who worked in the kindergarten. Eight cases were identified among household contacts; two of them were brothers, one from the kindergarten and another from the secondary school, where the outbreak occurred after the kindergarten outbreak. The estimated values of the basic reproduction number R0 were very low and it is very likely that asymptomatic infectious cases have occurred. The local health authority produced written documents and met with staff members and parents. Primary healthcare facilities and the obstetric department of the local hospital were also informed. As we are approaching the elimination of measles in Portugal and the rest of Europe, with very high vaccine coverage, it is very likely that a high proportion of infectious non-vesicular exanthemas will be due to B19 infections. This is to be taken into account in the design and conduct of surveillance activities, in the context of measles and rubella elimination programmes.

Infectious diseases surveillance activities in the north of Portugal, during the EURO 2004 football tournament

A European football tournament (EURO 2004) took place in Portugal, from the 12 June to the 4 July 2004. Portugal's Northern Regional Health Authority serves a population of 3.2 million people. This region hosted 12 matches, more than any other region. We describe the communicable disease surveillance activities in the region, during EURO 2004. Ten foodborne outbreaks, seven cases of meningococcal disease and one case of legionnaires disease, were detected. Visitors were not affected, furthermore, cases among residents seemed not to be influenced by the presence of thousands of visitors. A similar pattern has been observed at other mass gatherings where special surveillance activities were implemented. This does not reduce the importance of public health surveillance during such mass gatherings. Furthermore, evaluation of this special activities should be an opportunity to put, issues of communicable disease surveillance resources, priorities, organisation and training back on the agenda.

Foodborne outbreaks in northern Portugal, 2002

In October 2001, foodborne outbreaks (FBO) were included in the Portuguese alert and response surveillance system. Accordingly, the northern regional health authority (Delegado Regional de Saúde do Norte - DRSN) began a surveillance programme of foodborne outbreaks. This report is a brief description of data generated from this programme in 2002. For each foodborne outbreak the local health authority (Delegado de Saúde Concelhio - DSC) produced a written report. Fifty-nine percent of the 27 FBOs studied by DSCs during 2002 were reported within 72 hours after the date of onset. Five hundred and seventy seven people became ill, 9.6% of the patients were admitted to hospital, and no deaths were reported. The aetiological agent was identified from patients in 63% of FBOs, and in food items in 18.5% of the situations. Salmonella enterica was responsible for 73.7% of the outbreaks in which the agent was laboratory confirmed. Meals implicated in the outbreak were mainly prepared in restaurants and private homes (75.0% of FBO). Inadequate processing, preparing or handling of foods were the contributing factors more often reported by the DSC. We believe that epidemiological surveillance and control of FBO must be reinforced in Portugal as part of a wider strategy to promote food safety.

An outbreak of legionnaires' disease in a municipality in northern Portugal

Eleven cases of legionnaires' disease, all patients living in the same municipality, were admitted to a district hospital in northern Portugal. Preliminary investigations suggested an association with the events of the annual festivities in that municipality. Legionella pneumophila was not isolated from any of the suspected sources, but evidence from a case control study suggested that an aerosol produced by a decorative fountain in the main square during the night of a rock concert was the likely vehicle of infection. The prevalence of smoking was higher among cases than controls.

An outbreak of legionnaires’ disease in a municipality in northern Portugal

Eleven cases of legionnaires´ disease, all patients living in the same municipality, were admitted to a district hospital in northern Portugal. Preliminary investigations suggested an association with the events of the annual festivities in that municipality. Legionella pneumophila was not isolated from any of the suspected sources, but evidence from a case control study suggested that an aerosol produced by a decorative fountain in the main square during the night of a rock concert was the likely vehicle of infection. The prevalence of smoking was higher among cases than controls.

An outbreak of legionnaires disease in a municipality in northern Portugal

Eleven cases of legionnaires disease, all patients living in the same municipality, were admitted to a district hospital in northern Portugal. Preliminary investigations suggested an association with the events of the annual festivities in that municipality. Legionella pneumophila was not isolated from any of the suspected sources, but evidence from a case control study suggested that an aerosol produced by a decorative fountain in the main square during the night of a rock concert was the likely vehicle of infection. The prevalence of smoking was higher among cases than controls.

Genetic fingerprinting of Brevibacterium linens by pulsed-field gel electrophoresis and ribotyping

Members of Brevibacterium linens display physiological features that are relevant for cheese production. The genomes of five B. linens strains deposited on culture collections were compared by examining large restriction fragments on pulsed-field gel electrophoresis and detection of polymorphism at the level of 16S rRNA genes. Pulsed-field analysis with the endonucleases DraI and AsnI showed a characteristic restriction profile for each strain and allowed the calculation of genome sizes ranging between 3.2 and 3.9 Mbp. No linear genomic elements were detected. Polymorphisms at the level of 16S rRNA genes were revealed by hybridization with an oligonucleotide probe complementary to a universal domain of the 16S genes. An EcoRI fragment of 1.4 kb was identified as common to all strains under study. According to the number of positive bands detected by the probe, at least four rRNA operons must be present on the genome of the B. linens strains here studied.

Long-term effect of lovastatin on lipoprotein profile in patients with primary nephrotic syndrome

Eight patients with biopsy-proven primary nephrotic syndrome were included in an open, prospective, two-year study of lovastatin. One patients was withdrawn after 6 months due to an asymptomatic rise in creatinine phosphokinase, which was rapidly reversed after interruption of lovastatin. In the remaining patients, treatment was well-tolerated and produced no side effects. After 2 years of treatment, these 7 patients had decreases in total cholesterol from 446 +/- 165 to 250 +/- 57 mg/dl (p < 0.001), LDL cholesterol from 343 +/- 121 to 174 +/- 49 mg/dl (p < 0.001), Apo B lipoprotein from 162 +/- 60 to 108 +/- 42 mg/dl (p < 0.05), triglycerides from 336 +/- 273 to 182 +/- 71 mg/dl (p < 0.04). There was no change in HDL cholesterol. The LDL/HDL cholesterol and the total/HDL cholesterol ratios fell from 15.0 +/- 12.1 and 19.1 +/- 17.2 mg/dl before the study to 4.4 +/- 1.2 and 6.3 +/- 1.6 mg/dl, respectively, at 2 years. A decrease in proteinuria from 8.6 +/- 4.6 to 5.0 +/- 3.7 g/24 h (p < 0.02) was noted in 4 patients on concomitant ACE inhibitor therapy. Renal function remained stable in all patients throughout the study, except for one whose moderate impairment progressed to end-stage renal failure requiring dialysis 3 months poststudy. We conclude that long-term lovastatin in patients with primary nephrotic syndrome is an effective and generally safe treatment for accompanying dyslipidemia.

[Cytomegalovirus infection in kidney transplantation]

150 patients, subjected to kidney graft transplantation between January 1988 and December 1989, were studied. Mean +/- 95% CL age was 37.5 +/- 2.03 (range 12-69) years. IgG and IgM antibodies levels (ELISA) cytomegalovirus (CMV) were investigated in the donor before organ harvesting and in the kidney recipients on 1st and 21th days and then on the 3rd, 6th and 9th months after transplantation. Patients lacking either donor or 1st day studies were excluded. 133 donor (D) receptor (R) pairs were classified as group 1) D+/R+, 2) D+/R-, 3) D-/R+ e 4) D-/R-. Prevalence, severity of CMV disease and date of diagnosis were studied. Mean time +/- 95% CI of diagnosis after transplantation was 78.4 +/- 15.1 days. Seronegative receptors had a statistically significant higher prevalence of the disease as to seropositive receptors, but not a higher incidence of disease severity. One out of five patients had a serious form of disease. Hiperimmune globulin was used in 15 patients (all serious forms and 3 moderate forms of of disease). No patient died as a result of CMV infection.

[Acute renal insufficiency as presentation form of multiple myeloma]

Multiple Myeloma (MM) causes a wide range of serious clinical, alterations, including acute renal failure (ARF) often present and contributing to the global mortality of this neoplasm. ARF usually occurs well after MM is diagnosed. We describe a case of ARF in a 42 years old male patient requiring urgent hemodialysis that subsequently proved to have MM. The singularity of this case lead us to review cases of ARF admitted to the Nephrology Department between 1978 and 1990. We describe 7 patients (4 male) with ARF as presenting form of MM. Their mean +/- SD age was 60.0 +/- 10.6 (range 42-73). ARF with conserved diuresis was the presenting form in 6, 5 has systemic infection, and none was hypertensive. Replacement therapy with hemodialysis was needed in 6 patients and plasmapheresis was performed in 3. 4 patients died while admitted, 2 were discharged on chronic hemodialysis and there was recovery of renal function in 1 patient.

[Kidney disease and pregnancy. Experience at the nephrology unit of Saint Mary's Hospital]

29 pregnancies in 27 renal patients were reviewed. The etiology of renal disease was mainly glomerular (14 patients). At the beginning of pregnancy 11 patients had renal failure and 14 patients had a high blood pressure. Only two patients had pregnancy related worsening of the renal function (the two patients had a normal renal function before pregnancy). Maternal morbidity was infrequent with no mortality. Fetal loss was 21.5% related to prematurity. There were no congenital anomalies. Renal failure at the beginning of pregnancy caused an obstetric risk factor. (greater fetal prematurity and mortality).