Acute renal failure (ARF) in children has a poor prognosis in spite of modern therapeutic techniques. For this reason, it would be useful to have prognostic indicators early in the course of the disease, in order to identify those patients that could benefit most from aggressive treatment. In an attempt to establish valid prognostic factors, we prospectively studied 138 cases of ARF in children. We examined age, sex, etiology of ARF, previous surgery, prerenal origin, clinical situation of the patient when first seen by the nephrologist and complications. All these variables were statistically analyzed individually by univariate tests and, except for sex and complications, also by multiple regression analysis. Median age of the patients was 26 months. The etiology of ARF was nephropathy in 16, tumor in 14, cardiopathy in 85 and other causes in 23 cases. For analysis, patients were divided into patients with and without prerenal ARF. In the prerenal group, mortality-related factors were hypotension, need for ventilatory support, age less than 1 month and serum values of creatinine. In the nonprerenal ARF group, the need for assisted ventilation and the need for dialysis correlated positively with the mortality, while an exclusive nephrological etiology was associated with less probability of death.

Background: The metabolic syndrome (MS) is associated with insulin resistance (IR), a systemic lowgrade inflammatory state and endothelial dysfunction. These disorders may arise at a very early age in obese children. This study aimed to investigate the relationship between endothelial dysfunction and both IR and inflammation in prepubertal obese children. Methods and results: Von Willebrand factor (vWF) and soluble intercellular adhesion molecule-1 (sICAM-1) levels were measured in 46 obese prepubertal children aged 6-9, and in 46 non-obese, ageand sex-matched controls; the possible association of these levels with MS, various inflammatory biomarkers and plasminogen activator inhibitor-1 (PAI-1) was analyzed. Obese children displayed significantly elevated values for sICAM-1 (PZ0.008), vWF (PZ0.034), insulin (PZ0.006), homeostasis model assessment for IR (HOMA-IR; PZ0.003), C-reactive protein (CRP) (P!0.001), PAI-1 (PZ0.002) and leptin (P!0.001). Nonsignificant differences were found in interleukin 6 (IL-6) levels. In the obese group, sICAM-1 showed a positive correlation with insulin (PZ0.013), HOMA-IR (PZ0.015), CRP (PZ0.020), IL-6 (PZ0.023) and PAI-1 (PZ0.015). Corrected for age and sex, insulin, HOMA-IR, IL-6 and CPR were found to be independent predictive factors for sICAM-1. Conclusions: Prepubertal obese children displayed alterations indicative of endothelial dysfunction as well as disorders typical of MS. An association was established between endothelial dysfunction, IR, inflammation and inappropriate fibrinolysis in the children studied.

e21526 Background: Primary sarcomas of the breast (PBS) are a heterogeneous group of tumors from stromal breast, infrequent (0.1% of BC). Diagnosis and treatment is unclear. We analyzed all cases of PBS from BC diagnosed at our institution from 2004 to 2008. Methods: Histopathological specimens of PBS were reviewed (excluded phylloides, metaplastic and sarcomatoids carcinomas). A single-independent pathologist revised biopsies to confirm histology features (H&E) and inmunohistochemistry (IHC) setting: p53, ki67, vimentine, oestrogen and cerbB2 receptors, CD31/34, cito-keratins (CK) and histology grade. We revised image methods (mammography, ultrasound or IRM/TC) and surgery make. We analysed diseases outcomes (disease free survival, DFS) by histology high risk factors (tumor size, histology, and proliferation index). Heterogeneous chemotherapy/radiotherapy schedules was evaluated . Statistical analysis with G-Stat 2.0 was performed. Results: Seven cases of PBS (1 male/6 female) were reviewed, from 790 BC diagnosed (0.8%): 2 angiosarcomas (AS), 1 malignant fibrous histiocytoma, 2 undifferentiated, one osteoclastic and other spindle-cell sarcoma. Mean age was 63 years, 3 image-techniques used in 71.4% patients (pts), lumpectomy was performed in 71.4%. IHC: vimentine + and CK- in all cases, CD31/CD34+ in AS. P53 and Ki67 were not significantly associated with DFS (p=0.33 and p=0.88 respectively), tumor size (mean 7.4 cm) neither (T-Student test, p=0.80). Adjuvant therapy was radiation 57.14% pts; and chemotherapy (doxorubicin 4/liposomal doxorubicin 2 pts) in recurrence. Three pts have died with distant metastases (DFS mean: 11.7 months; Kaplan-Meier method). Contralateral low grade AS in one woman, and lung adenocarcinoma in the man, had been diagnosed 2 years later. Conclusions: PBS are rare and difficult diagnosis tumors. There are few series published, without prospective studies to evaluate an adequate therapy, diagnosis and valuable prognostic factors. Our incidence was high, but the independent pathology analysis confirmed all histopathological diagnosis. This review included novel IHC and IRM images, considered necessary for diagnosis and personalized treatment. No significant financial relationships to disclose.

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