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-Objective: The aim of this report is to describe a fatal disseminated thrombotic micoangiopathy with renal, pancreatic, and cerebral involvement in a patient with recently diagnosed adult's Still disease (ASD). Case report: A previously healthy 15 year old girl was admitted to our hospital. According to the clinical and laboratory data the diagnosis of adult's still Disease was established. The treatment was begun and few days after an initial improvement a sudden neurologic deterioration with coma and seizures has occurred. Hours later the patient died. Clinical, laboratorial, and pathologic data will be presented. Conclusion: To our knowledge this is the second description of a fatal disseminated cerebral thrombotic microangiopathy in a patient with adult's Still disease, but with a much more fulminating evolution than previously reported. Some etiopathogenic mechanisms could be shared in these two disorders explaining this coexistence.KEY WORDS: adult's Still disease, cerebral thrombotic microangiopathy, thrombotic thrombocitopenic purpura.Microangiopatia trombótica cerebral em um paciente com doença de Still do adulto Microangiopatia trombótica cerebral em um paciente com doença de Still do adulto Microangiopatia trombótica cerebral em um paciente com doença de Still do adulto Microangiopatia trombótica cerebral em um paciente com doença de Still do adulto Microangiopatia trombótica cerebral em um paciente com doença de Still do adulto RESUMO -Objetivo: O objetivo deste estudo é relatar um caso fatal de microangiopatia trombótica, com envolvimento dos rins, pâncreas e cérebro, concomitantemente a um quadro recém diagnosticado de doença de Still do adulto. Caso: Uma paciente de 15 anos, previamente saudável, foi admitida em nosso serviço. Os dados clínicos e laboratoriais levaram ao diagnóstico de doença de Still do adulto. Após alguns dias do início do tratamento e uma melhora inicial, houve súbita deterioração do nível de consciência e convulsões, tendo a paciente evoluido para o óbito horas após. Os dados clínicos, laboratoriais e anátomo patológicos serão apresentados. Conclusão: Trata-se do segundo caso fatal de microangiopatia trombótica fatal em paciente com doença de Still do adulto, mas com evolução neurológica muito mais rápida e fulminante que no caso anteriormente descrito. Mecanismos etiopatogenéticos comuns poderiam explicar a coexistência destas duas doenças.PALAVRAS-CHAVE: doença de Still do adulto, púrpura trombocitogênica trombótica, microangiopatia trombótica.

Objective: to compare the data obtained from the CDI500® and Spectrum M4® to assess the reliability of the results and their impact on cardiopulmonary bypass. Methods: a prospective observational study of patients undergoing cardiac surgery with CPB was conducted between January-2017 and February-2018. The data provided by CDI and M4 was collected. Arterial and venous blood gases taken from Radiometer ABL90 Flex® were used as control. With the first sample, the data of both analyzers were adjusted. A minimum of two samples and a maximum of four were made. Results: 100 patients and 292 samples (32% women) with a mean age of 65.2 ± 11.5 years were studied. The parameters of the CDI and M4 practically did not present significant differences after the first adjustment, and without affecting the clinical practice, except in the bicarbonate and the excess of base where CDI does not adjust to the values. The analysis was done with the Bland/Altman charts, the PCO2 and PO2 were better measured by the CDI while Hto, Hb and SvO2 by M4, which was corroborated comparing the error percentages less than ± 5% in both systems, the significant differences being in the five parameters. Conclusions: both systems provide reliable data, although they require a previous calibration. The M4 allows direct evaluation of data to help a goal directed perfusion.

Objective: to assess the relationship between oxygen delivery during cardiopulmonary bypass and the incidende of acute kidney injury in the immediate postoperative period of patients undergoing cardiac surgery, as well as to identify possible risk factors. Methods: A retrospective observational study of patients undergoing cardiac surgery scheduled between May 2016 and February 2018 was carried out in which the M-M4 System was used for online blood gases. Patients with preoperative diagnosis of chronic renal failure were excluded. For the oxigen delivery, the average of all M4 records was made. Results: 133 patients (35.3% women) with a mean age of 64.9 ± 10.9 years were studied. The incidence of acute kidney injury was 18.8% (AKI I: 12%; AKI II: 3%; AKI III: 3.8%). There was no correlation between acute kidney injury and O2 delivery (251 ± 43 vs 247 ± 52, ns), if there was a difference when patients needed renal replacement therapy (251 ± 43 vs 198 ± 18, p = 0.04). There was a significant increase risk in diabetes; HTA; pulmonary arterial hypertension; chronic atrial fibrilation; red blood cell concentrate and blood products administration in the operating room; redo for bleeding; high lactic acid and glycemia post cardiopulmonary bypass; prolonged pump and ischemia times; and combined surgery. Conclusions: There was no direct relationship between O2 delivery and acute kidney injury, although there was a significantly lower O2 delivery in patients who needed postoperative renal replacement therapy.