Association between visceral/subcutaneous adipose tissue ratio and plasma inflammatory markers and score for cardiovascular risk prediction in a Brazilian cohort: Pró-Saúde Study

Visceral adipose tissue (VAT) is associated with various metabolic disorders, and adipokines, secreted by adipose tissue, are involved in their pathogenesis. This study investigated associations between VAT/subcutaneous adipose tissue (SAT) ratio, inflammatory markers, and cardiovascular (CV) risk-score in adults. Plasma levels of adipokines, plasma lipid profile, blood pressure, and body composition (using dual-emission x-ray absorptiometry) were determined. CV risk-score based on the American College of Cardiology and the American Heart Association (ACC/AHA) score was calculated in a sample of 309 Brazilian civil servants aged <60 years. Participants' VAT/SAT ratio were categorized into quartiles. Among males, plasma leptin (2.8 ng/mL) and C reactive protein (CRP) (0.2 mg/dL) (P<0.05) levels were higher at P75 and P50 than P5, and the highest calculated CV risk-score was observed at P75 (7.1%). Among females, higher plasma adiponectin levels were observed at P25 (54.3 ng/mL) compared with P75 (36 ng/mL) (P<0.05). Higher plasma CRP levels were observed at P75 (0.4 mg/dL) compared with P5 (0.1 mg/dL) (P<0.05). Higher CV risk-score was observed at P75 (2.0%) compared with P5 (0.7%). In both sexes, VAT and VAT/SAT ratio were directly associated with plasma leptin, CRP, and CV risk-score, and inversely associated with adiponectin; SAT was directly associated with plasma leptin and CRP (P<0.01); interleukin (IL)-10 and CRP were directly associated with adiponectin and leptin, respectively (P<0.05). Among men only, IL-10 (inversely) and CRP (directly) were associated with CV risk-score (P=0.02). Our results strengthened the relevance of the VAT/SAT ratio in cardiovascular risk.

Clinical and urodynamic evaluation in women with stress urinary incontinence treated by periurethral collagen injection

OBJECTIVE: To evaluate the success of treatment with periurethral collagen injections in patients suffering from stress urinary incontinence (SUI) with bladder neck hypermobility and intrinsic sphincter deficiency MATERIALS AND METHODS: Forty women suffering from (SUI) were selected and divided into GI (consisting of 13 women with SUI and bladder neck hypermobility) and GII (consisting of 27 women with SUI and intrinsic sphincter deficiency). Periurethral collagen was injected followed by a subjective evaluation (the need for urinary protectors) and an objective evaluation through urodynamic study before and after the treatment RESULTS: It was noticed that after 9 months there was a decrease in the need of urinary protectors in the two groups. It was observed through the urodynamic study that either cure or improvement was achieved in 46 percent in GI and 40.7 percent in GII. There was a significant increase in the leak pressure in GII. Moreover, there was a decrease in the volume of urine leak in the two groups, being the results in GII statistically significant CONCLUSIONS: It was concluded that the periurethral collagen injection is useful for the treatment of the SUI. The results in hypermobility are similar to those in intrinsic sphincter deficiency. In fact, it is a very simple out patient's procedure, with little side effects.

Peritoneal fluid modulates the sperm acrosomal exocytosis induced by N-acetylglucosaminyl neoglycoprotein

The effect of peritoneal fluid (PF) on the human sperm acrosome reaction (AR) was tested. Sperm was pre-incubated with PF and the AR was induced by calcium ionophore A23187 and a neoglycoprotein bearing N-acetylglycosamine residues (NGP). The AR induced by calcium ionophore was inhibited 40 percent by PF from controls (PFc) and 50 percent by PF from the endometriosis (PFe) group, but not by PF from infertile patients without endometriosis (PFi). No significant differences were found in the spontaneous AR. When the AR was induced by NGP, pre-incubation with PFc reduced (60 percent) the percentage of AR, while PFe and PFi caused no significant differences. The average rates of acrosome reactions obtained in control, NGP- and ionophore-treated sperm showed that NGP-induced exocytosis differed significantly between the PFc (11 percent) and PFe/PFi groups (17 percent), and the ionophore-induced AR was higher for PFi (33 percent) than PFc/PFe (25 percent). The incidence of the NGP-induced AR was reduced in the first hour of pre-incubation with PFc and remained nearly constant throughout 4 h of incubation. The present data indicate that PF possesses a protective factor which prevents premature AR

Ovarian activity before and after gonadal suppression by GnRH-a in patients with polycystic ovary syndrome, hyperandrogenism, hyperinsulinism and acanthosis nigricans

Objective. To investigate the ovarian activity before and after gonadal suppression with GnRH-analog in patients with PCO, hyperandrogenism, hyperinsulinism and ancathosis nigricans. Design: Controlled clinical study. Setting: Tertiary academic medical center. Patients: Six patients with clinical findings of PCO, hirsutism and acanthosis nigricans. Interventions. Morning blood samples in the follicular phase to determine the seteroid levels, glucose and insulin curve, comparing to a control group. Administration for 2 consecutive months of a GnRH-analog, comparing, in the study group, the free testosterone levels before and after ovarian suppression. Main Outcome Measure. Determination of insulin levels in PCO, hirsutism and acanthotic patients and the free-testosterone levels before and after gonadal suppression. Results. Insulin levels were significantly higher in the study group when compared to normal women during the glycemic test. We also found a significant decrease in the free-testosterone levels after 2 months of gonadal suppression with GnRH-analog when compared to the initial time. Conclusions. Patients with PCO, hirsutism and acanthosis nicrigans present high levels of in sulin, suggesting an ovarian hyperesponsiveness, which is not sustained when gonadotrophic blockage was achieved.

Tratamento cirúrgico da incontinência urinária de esforço: análise de resultados pelas vias abdominal e vaginal / Surgical treatment of stress urinary incontinence: analysis of the results by abdominal or vaginal pathways

OBJETIVO. Propoe-se, neste trabalho, analisar os resultados pós-operatórios de 367 cirurgias para correçao de incontinência urinária de esforço, quanto à época de aparecimento e ocorrência de recidivas. MATERIAL E MÉTODO. Os casos foram reunidos em quatro grupos: A = 206 (56,1 por cento) casos - cirurgia de Kelly-Kennedy; B = 37 (10,1 por cento) - cirurgia de Kelly- Kennedy associada à histerectomia vaginal; C = 95 (25,9 por cento) - cirurgia de Burch e, finalmente, D = 29 (7,9 por cento) - cirurgia de Burch associada à histerectomia total abdominal. RESULTADOS. O tempo de seguimento pós-operatório variou de 1 a 194 meses, com média de 31 meses. Observou-se incidência de recidivas de 20,1 por cento no grupo D e de 10,8 por cento no grupo B. Em 68,7 por cento das cirurgias por via vaginal e em 82,3 por cento pela abdominal, as recidivas ocorreram em menos de três anos. CONCLUSAO. Nao houve diferença estatisticamente significante no aparecimento de recidivas pós-operatórias nos três grupos estudados. A maior parte das recidivas ocorreu nos primeiros três anos após a cirurgia.

Braquiterapia no tratamento do cancer da mama - resultados preliminares. / Braquitherapy in the treatment of breast cancer - preliminary results

Os autores apresentam 22 casos de carcinoma de mama tratados por irradiacao exclusiva, demostram sua tecnica e tecem comentarios comparativos entre o tratamento irradiante exclusivo e o cirurgico

Tumor de celulas da granulosa do ovario com atividade androgenica. / Granulosa cell tumor of the ovary with androgenic activity

Os autores apresentam um caso raro de tumor de celulas da granulosa com atividade masculinizante em uma paciente nulipara de 35 anos de idade. Apresentava amenorreia, hirsutismo e aumento do clitoris.Encontraram-se niveis elevados de DHEA, S-DHEA e testosterona. Havia importante diferenca entre a concentracao de testosterona entre o sangue venoso periferico e da veia ovariana. Os niveis de androgenios cairam aos limites normais apos a remocao do tumor.Apenas 11 casos bem documentados foram ate agora publicados, e parece que este e o primeiro no qual se analisou o comportamento dos androgenios no sangue da veia periferica e no da ovariana

Tumor do seio endodermico do ovario. / Endodermal sinus tumor of the ovary

Os autores estudam um caso de tumor no seio endodermico; neoplasia rara, de linhagem germinativa em paciente de 14 anos de idade, com queixa clinica de crescimento progressivo de abdome. Os exames clinico e ginecologico revelaram abdome abaulado, tenso, com sinais de ascite e presenca de um tumor palpavel no hipogastrico. O achado operatorio mostrou o ovario esquerdo transformado em tumor de aproximadamente 12 cm de diametro, sem sinais de propagacao (estadio lai). O exame histopatologico revelou tumor do seio endodermico. A vista da idade da paciente e do estadiamento do tumor, optou-se, apesar de sua indubitavel malignidade, pela cirurgia conservadoura: anexectomia unilateral com biopsia do ovario contralateral e do omento, complementado pela poliquimioterapia.A citologia do liquido peritoneal e a biopsia do ovario oposto e do omento foram negativas. Decorridos quase tres anos da cirurgia, a paciente acha-se viva, aparentemente sem sinais clinicos de recidiva nem de metastases

Uso de prostaglandina F2 alfa para inducao do trabalho de parto. Efeitos maternos e fetais. / Use of prostaglandin F aphal(ing) to induce labor. Maternal and fetal effects

Os autores utilizaram prostaglandina F2 alfa na inducao do parto em 19 pacientes com idade gestacional superior a 35 semanas. Em doses adequadas, nao houve complicacoes clinicas de grande importancia, a nao ser em um caso onde acidentalmente ocorreu superdosagem.Em apenas uma vez ocorreu falta da inducao. Os recem-nascidos tiveram indice de Apgar satisfatorio e apresentaram ocorrencia nao usual de ictericia neonatal, que merece melhor investigacao

Hemorragia digestiva macica alta - complicacao rara e grave do puerperio. / Severe upper gastric hemorrhage - rare and serious complication of puerperium

Os autores apresentam um caso raro de paciente que apresentou quadro grave de hemorragia gastrica no quarto dia de pos-operatorio de cesarea, na vigencia de infeccao puerperal.Sugerem estar emquadrado dentro do diagnostico de gastrite aguda toxico-infecciosa da classificacao de Bockus, complicacao muito pouco frequente, devida a toxinas bacterianas e que pode ocorrer como consequencia de qualquer processo infeccioso