Minor sperm abnormalities in young male post-pubertal patients with juvenile dermatomyositis

The objective of the present study was to identify sperm abnormalities in young male patients with juvenile dermatomyositis (JDM). In 2005, 18 male JDM patients, diagnosed according to the criteria of Bohan and Peter, were followed at the Pediatric Rheumatology Unit and Rheumatology Division, of our Institution. Of the 18 males, 11 were pre-pubertal and 7 were post-pubertal. Two of 7 post-pubertal JDM male patients were excluded: one for orchidopexy for cryptorchidism and the other for testicular ectopia in the left testis. The remaining 5 post-pubertal JDM patients were prospectively evaluated on the basis of two semen analyses, according to the World Health Organization (WHO), urologic evaluation, testicular Doppler ultrasound hormone profile. The data of the JDM patients were compared with those of 5 age-matched healthy controls. The median age 18, was similar in JDM patients and controls. All JDM patients had teratozoospermia (abnormal sperm morphology), as did 4 (80 percent) of the controls. One of JDM patients had previous oligoasthenoteratozoospermia treated with intravenous cyclophosphamide with normalization of the number and concentration of the sperm after 5 years. All sperm parameters (sperm concentration, total sperm count and total motile sperm count by WHO, and sperm morphology by Kruger strict criteria), testicular volumes by Prader orchidometer and ultrasound, and hormones were similar in JDM patients compared with controls. The frequency of anti-sperm antibodies was similar in both groups. All JDM patients had minor sperm abnormalities in the head, midpiece, and/or tail of spermatozoids. Serial semen analyses in larger study populations are necessary to identify the extent and duration of sperm abnormalities in male patients with idiopathic inflammatory myopathies.

Bone metabolism and vascular calcification

Osteoporosis and atherosclerosis are chronic degenerative diseases which have been considered to be independent and whose common characteristic is increasing incidence with age. At present, growing evidence indicates the existence of a correlation between cardiovascular disease and osteoporosis, irrespective of age. The morbidity and mortality of osteoporosis is mainly related to the occurrence of fractures. Atherosclerosis shows a high rate of morbidity and especially mortality because of its clinical repercussions such as angina pectoris, acute myocardial infarction, stroke, and peripheral vascular insufficiency. Atherosclerotic disease is characterized by the accumulation of lipid material in the arterial wall resulting from autoimmune and inflammatory mechanisms. More than 90 percent of these fatty plaques undergo calcification. The correlation between osteoporosis and atherosclerosis is being established by studies of the underlying physiopathological mechanisms, which seem to coincide in many biochemical pathways, and of the risk factors for vascular disease, which have also been associated with a higher incidence of low-bone mineral density. In addition, there is evidence indicating an action of antiresorptive drugs on the reduction of cardiovascular risks and the effect of statins, antihypertensives and insulin on bone mass increase. The mechanism of arterial calcification resembles the process of osteogenesis, involving various cells, proteins and cytokines that lead to tissue mineralization. The authors review the factors responsible for atherosclerotic disease that correlate with low-bone mineral density.

Desenvolvimento de equação para estimativa da gordura corporal de mulheres idosas com osteoporose e osteopenia através da espessura de dobras cutâneas tendo como referência absorciometria por dupla emissão de raios X / Development of an equation for measurement of bodyfat mass of elderly women with osteoporosis or osteopenia through skin fold thickness using dual energy X-ray absorptiometry as a reference

INTRODUÇÃO E OBJETIVO: A composição corporal vem sendo descrita como importante fator relacionado à densidade mineral óssea. Assim, o presente estudo teve como objetivo desenvolver equação preditiva para percentagem de gordura corporal através da espessura de dobras cutâneas tendo como referência a absorciometria por dupla emissão de raios X (DXA), em mulheres com osteoporose e osteopenia. METODOLOGIA: Foram analisadas 29 mulheres com idade entre 67 e 84 anos, atendidas no Ambulatório de Osteoporose da Disciplina de Reumatologia da Faculdade de Medicina da Universidade de São Paulo. Foram mensuradas as espessuras de quatro dobras cutâneas (bíceps, tríceps, subescapular e supra-ilíaca) e realizada a avaliação da composição corporal pela DXA. A análise estatística constou do teste de Kolmogorov-Smirnov, coeficiente de correlação de Pearson, análise de regressão linear simples, coeficiente de correlação intraclasse, teste t de Student, teste de Bland-Altman e cálculo do erro total da equação de acordo com Lohman (1992). RESULTADOS: O modelo de espessura de dobras cutâneas que melhor explicou o percentual de gordura corporal incluiu a soma das dobras supra-ilíaca, bicipital e tricipital, determinando em até 72 por cento a percentagem de gordura corporal. Os valores médios da gordura corporal em quilograma, estimados pelas dobras e medidos pela DXA, não foram estatisticamente diferentes e estiveram altamente correlacionados (r = 0,82; p < 0,001). Comparando-se o percentual de gordura corporal avaliado pela equação proposta e o medido pela DXA, o erro total foi de 0,7 por cento e 0,4kg. CONCLUSÃO: Em vista dos presentes resultados, a equação resultante do modelo de regressão linear é adequada para as mulheres idosas com osteoporose e osteopenia, podendo ser uma alternativa para a estimativa de gordura corporal nesse tipo de população.

INTRODUCTION AND OBJECTIVE: The body composition has been intensively investigated as a determinant of bone mineral density. The present study was developed in order to propose a predictive equation to calculate body fat percentage by means of skin folds thickness using bone densitometry (DXA) as a reference in a group of elderly women with osteoporosis and osteopenia. METHODOLOGY: Twenty-nine women, mean age 67 to 84 years old, in attendance at the Osteoporosis Clinic at Rheumatology Division, School of Medicine, University of Sao Paulo, were evaluated. Four skin folds thickness were measured (biceps, triceps, subscapular and suprailiac) and body composition by DXA was evaluated. The statistical analysis consisted of Kolmogorov-Smirnov test, Pearson's coefficient correlation, simple linear regression analysis, intra-class correlation coefficient, t Student test, Bland-Altman test and calculus of equation total error according to Lohman (1992). RESULTS: The best skinfold model that explained the percentage of body fat mass included the suprailiac, bicipital and tricipital values, determining up to 72 percent of body fat mass. The fat mass average values in kilograms estimated by the skin folds and measured by DXA were not statistically different and had been highly correlated (r = 0.82; p < 0.001). Comparing the fat mass percentage evaluated by the proposed equation and the percentage measured by DXA, the total error was of 0.7 percent and 0.4 kg. CONCLUSION: In view of the presented results, the resultant equation of the regression model is adequate for elderly women with osteoporosis and osteopenia, and may be an alternative for the body fat mass estimate in this population.

INTRODUCCION Y OBJETIVO: La composición corporal viene siendo descrita como un importante factor relacionado a la densidad mineral ósea. De este modo el presente estudio ha tenido como objetivo desarrollar una ecuación predictiva para el porcentaje de grasa corporal a través de la espesura de los dobleces cutáneos con bases en la absorciometría por doble emisión de rayos X (DXA), en mujeres con osteoporosis y osteopenia. METODOLOGíA: Fueron analizadas 29 mujeres con edades entre 67 y 84 años, atendidas en Ambulatorio de Osteoporosis de la Disciplina de Reumatología de la Facultad de Medicina de la Universidad de San Pablo. Fueron medidas las espesuras de cuatro dobleces cutáneos (bíceps, tríceps, subescapular y suprailiaca) y realizada la evaluación de la composición corporal por DXA. El análisis estadístico constó del test de Kolmogorov-Smirnov, el coeficiente de correlación de Pearson, el análisis de regresión lineal simple, el coeficiente de correlación intraclase, el test t de Student, el test de Bland-Altman y el cálculo del error total de la ecuación de acuerdo a Lohman (1992). RESULTADOS: El modelo de espesura de dobleces cutáneos que mejor explicó el porcentaje de grasa corporal incluyó la suma de los dobleces suprailiaco, bicipital y tricipital, determinando en hasta 72 por ciento el porcentaje de grasa corporal. Los valores medios de grasa corporal en kilogramos, estimados por los dobleces y medidos por el DXA, no fueron estadísticamente diferentes y estuvieron altamente correlacionados (r = 0,82; p < 0,001). Al compararse el porcentaje de grasa corporal evaluado por la ecuación propuesta y el medido por el DXA, el error total fue de 0,7 por ciento y 0,4 kg. CONCLUSION: A la luz de los resultados obtenidos, la ecuación resultante del modelo de regresión lineal es adecuada para las mujeres ancianas con osteoporosis y osteopenia siendo incluso una alternativa para la estimativa de la grasa corporal en este tipo de población.

RANK, RANKL and osteoprotegerin in arthritic bone loss

Rheumatoid arthritis is characterized by the presence of inflammatory synovitis and destruction of joint cartilage and bone. Tissue proteinases released by synovia, chondrocytes and pannus can cause cartilage destruction and cytokine-activated osteoclasts have been implicated in bone erosions. Rheumatoid arthritis synovial tissues produce a variety of cytokines and growth factors that induce monocyte differentiation to osteoclasts and their proliferation, activation and longer survival in tissues. More recently, a major role in bone erosion has been attributed to the receptor activator of nuclear factor kappa B ligand (RANKL) released by activated lymphocytes and osteoblasts. In fact, osteoclasts are markedly activated after RANKL binding to the cognate RANK expressed on the surface of these cells. RANKL expression can be upregulated by bone-resorbing factors such as glucocorticoids, vitamin D3, interleukin 1 (IL-1), IL-6, IL-11, IL-17, tumor necrosis factor-alpha, prostaglandin E subscrito 2, or parathyroid hormone-related peptide. Supporting this idea, inhibition of RANKL by osteoprotegerin, a natural soluble RANKL receptor, prevents bone loss in experimental models. Tumor growth factor-ß released from bone during active bone resorption has been suggested as one feedback mechanism for upregulating osteoprotegerin and estrogen can increase its production on osteoblasts. Modulation of these systems provides the opportunity to inhibit bone loss and deformity in chronic arthritis.

Mycobacterium simiae infection in a patient with acquired immunodeficiency syndrome

Mycobacterium simiae is usually an environmental contaminant rarely associated with human disease. We report a fatal case of M.simiae infection in a 37 year old, HIV positive, male from whom the organism was isolated from blood culture. The identification of M.simiae was performed using DNA amplification followed by analysis on 3 agarose gel of the amplicon fragments after digestion by restriction endonucleases. The precise identification of mycobacterial isolates to the species level is important, with both epidemiological and therapeutic implications.

Effect of 17á-estradiol or alendronate on the bone densitometry, bone histomorphometry and bone metabolism of ovariectomized rats

The objective of the present study was to evaluate the effect of 17á-estradiol or alendronate in preventing bone loss in 3-month-old ovariectomized Wistar rats. One group underwent sham ovariectomy (control, N = 10), and the remaining three underwent double ovariectomy. One ovariectomized group did not receive any treatment (OVX, N = 12). A second received subcutaneous 17á-estradiol at a dose of 30 æg/kg for 6 weeks (OVX-E, N = 11) and a third, subcutaneous alendronate at a dose of 0.1 mg/kg for 6 weeks (OVX-A, N = 8). Histomorphometry, densitometry, osteocalcin and deoxypyridinoline measurements were applied to all groups. After 6 weeks there was a significant decrease in bone mineral density (BMD) at the trabecular site (distal femur) in OVX rats. Both alendronate and 17á-estradiol increased the BMD of ovariectomized rats, with the BMD of the OVX-A group being higher than that of the OVX-E group. Histomorphometry of the distal femur showed a decrease in trabecular volume in the untreated group (OVX), and an increase in the two treated groups, principally in the alendronate group. In OVX-A there was a greater increase in trabecular number. An increase in trabecular thickness, however, was seen only in the OVX-E group. There was also a decrease in bone turnover in both OVX-E and OVX-A. The osteocalcin and deoxypyridinoline levels were decreased in both treated groups, mainly in OVX-A. Although both drugs were effective in inhibiting bone loss, alendronate proved to be more effective than estradiol at the doses used in increasing bone mass

Amplification of 9q34 in childhood adrenocortical tumors: a specific feature unrelated to ethnic origin or living conditions

Adrenocortical tumors (ACT) in children under 15 years of age exhibit some clinical and biological features distinct from ACT in adults. Cell proliferation, hypertrophy and cell death in adrenal cortex during the last months of gestation and the immediate postnatal period seem to be critical for the origin of ACT in children. Studies with large numbers of patients with childhood ACT have indicated a median age at diagnosis of about 4 years. In our institution, the median age was 3 years and 5 months, while the median age for first signs and symptoms was 2 years and 5 months (N = 72). Using the comparative genomic hybridization technique, we have reported a high frequency of 9q34 amplification in adenomas and carcinomas. This finding has been confirmed more recently by investigators in England. The lower socioeconomic status, the distinctive ethnic groups and all the regional differences in Southern Brazil in relation to patients in England indicate that these differences are not important to determine 9q34 amplification. Candidate amplified genes mapped to this locus are currently being investigated and Southern blot results obtained so far have discarded amplification of the abl oncogene. Amplification of 9q34 has not been found to be related to tumor size, staging, or malignant histopathological features, nor does it seem to be responsible for the higher incidence of ACT observed in Southern Brazil, but could be related to an ACT from embryonic origin.

Vasculite urticariforme hipocomplementêmica como primeira manifestaçäo do lúpus eritematoso sistêmico / Hypocomplementaemic urticarial vasculitis first manifestation of systemic lupus erythematosus

A síndrome vasculite urticariforme hipocomplementêmica é uma vasculite leucocitoclástica que se apresenta com lesöes urticariformes, associada a febre, artralgias, artrite e cólica abdominal. Outras manifestaçöes sistêmicas incluem a presença de glomerulonefrite, uveíte, episclerite, doença pulmonar obstrutiva e alteraçöes neurológicas. Alguns casos associados ao lúpus eritematoso sistêmico (LES) têm sido descritos, com o diagnóstico baseando-se na presença de critérios bem definidos de LES prévia ou concomitantemente ao aparecimento de vasculite urticariforme. A apresentaçäo de vasculite urticariforme precedendo o diagnóstico de LES é rara, o que motivou o relato destes dois casos. Enfatiza-se a positivaçäo do anticorpo anti-Ro/SS-A por ocasiäo do diagnóstico de LES, alertando para a necessidade de avaliaçäo periódica nos casos de vasculite urticariforme.

Leishmaniose tegumentar americana na regiäo nordeste do Estado de Säo Paulo - Brasil / American tegumentary leishmaniasis in the norheastern state of Säo Paulo - Brasil

Os autores descrevem um surto de leishmaniose tegumentar americana (LTA) instalado na regiao nordeste do Estado de Sao Paulo em 1992. Após a notificaçao de doze casos humanos em uma área rural do município de Itupeva, foi realizado um inquérito epidemiológico, destacando-se 34 por cento de positividade da populaçao à Reaçao Intradérmica de Montenegro. Constatou-se uma grande diversidade da fauna flebotomínica local, com predominância de L. migonei, L. intermedia e L. whitmani, tanto no domicílio, quanto na margem da mata. Ressalta-se a presença na margem da mata de L. longipalpis.

Eritromelalgia primária / Primary erythromelalgia

Eritromelalgia é uma afecçäo rara que se caracteriza por intenso rubor, dor em queimaçäo e aumento da temperatura das extremidades. Formas primárias e secundárias têm sido descritas, em particular com trombocitemia essencial e policitemia vera. Os autores fazem o relato de um paciente de 15 anos, portador de eritromelalgia primária, e discutem os aspectos patogênicos, clínicso e tarapêuticso dessa entidade

Carcinoma de celulas transicionais do rim: correlacao radiologica e ultrasonografica. / Transitional cell carcinoma of the Kidney: radiological and ultra-sonographic correction

Os achados ultra-sonograficos observados em nove pacientes com carcinoma de celulas transicionais do rim foram correlacionados com os achados da urografia excretora, da pielografia anterograda e/ou da pielografia retrograda. Em seis pacientes a hipotese diagnostica de tumor de vias coletoras renais foi corretamente considerada baseada nos achados da urografia excretora. Nestes pacientes o exame ultra-sonografico foi util na caracterizacao adequada desta entidade, excluindo outras possibilidades diagnosticas. Em outros tres pacientes, devido a suas manifestacoes incomuns, a ultra-sonografia foi fundamental para o diagnostico. Estas manifestacoes atipicas incluiram a demonstracao de massa na periferia de saco hidronefrotico, a demonstracao de massas papilares arborescentes em rim hidronefrotico e a deteccao de massa associada a processo inflamatorio da pelvis renal. Nenhum desses aspectos por nos observados sao descritos na literatura. Os diagnosticos diferenciais, bem como uma comparacao entre os nossos achados com os encontrados em 17 casos previamente citados na literatura sao tambem apresentados

Ultra-sonografia dos tumores retroperitoneais primarios. / Ultrasonography of primary retroperitoneal tumors

Os achados ultra-sonograficos de vinte casos de tumores retroperitoneais primarios foram analisados e agrupados, baseando-se na sua ecogenicidade e localizacao topografica. O valor da ultra-sonografia no diagnostico e na determinacao da extensao do processo tumoral, bem como a demonstracao de relacao destes tumores com os orgaos e estruturas anatomicas vizinhas, sao tambem apresentados

Contribuicao do estudo radiologico ao diagnostico dos polipos coanais e antro-coanais. / The radiologic study for diagnosis of coanal and antrochoanal polyps

Os autores relatam o estudo radiografico de dois pacientes portadores de polipo coanal e de dois pacientes portadores de polipo antro-coanal que foram examinados radiograficamente, usando-se metodos convencionais e procedimentos especiais, como angiografia e tomografia computadorizada.A contribuicao da radiologia foi a de afastar lesoes neoplasicas e fazer a localizacao anatomica precisa de afeccao, bem como o seu estadiamento

Retinoblastoma - valor da tomografia computadorizada no diagnostico e tratamento. / Retinoblastoma: value of computed tomography in the diagnosis and treatment

Os autores relatam o valor da tomografia computadorizada no diagnostico do retinoblastoma. Sao apresentados quatro casos e descritos os achados tomograficos e o papel da tomografia computadorizada como metodo propedeutico, permitindo uma precisa localizacao e extensao do tumor e seu valor no diagnostico, planejamento cirurgico e radioterapico e prognostico

Aspectos ultra-sonograficos do linfoma focal hepatico. / Ultrasonographic aspects of focal hepatic lymphoma

Os exames ultra-sonograficos hepaticos de 150 pacientes com linfoma foram revistos.Destes pacientes 38 apresentaram doenca de Hodgkin e 112 um tipo de linfoma nao-Hodgkin. Manifestacao focal do linfoma hepatico foi encontrada em sete pacientes (5%).Os aspectos predominantemente encontrados foram os de lesoes focais hipoecoicas e o de lesoes focais ecogenicas com halo hipoecoico periferico (lesoes "em alvo"). Estas manifestacoes ocorreram em linfomas Hodgkin e nao-Hodgkin

Doenca renal policistica do adulto correlacao clinico-laboratorial-sonografica em 32 casos. / Polycystic Kidney disease in adult: clinico-laboratorial and sonographic correlation in 32 cases

Foram examinados 32 pacientes portadores de doenca renal policistica do adulto (D.R.P.A.) pela ultra-sonografia, na tentativa de fornecer subsidios ao tratamento e ao prognostico da doenca. Todos os casos apresentaram alteracoes renais bilaterais, sete pacientes com cistos hepaticos e um que a presenca de parenquima renal poupado te. A correlacao entre achados sonograficos e as provas de funcao renal revelou que a presenca de parenquma renal poupado em proporcao menor ou igual a 30% do volume renal e frequentemente associada a alteracoes bioquimicas da ureia e creatinina A caracterizacao de cistos predominantes atraves da correta localizacao dos mesmos foi util para o alivio sintomatico em quatro pacientes, pois possibilitou a puncao percutanea esvaziadora ou a exerese de cistos volumosos. Em outros 3 pacientes com insuficiencia renal a ultra-sonografia foi fundamental, se levarmos em conta que outros metodos diagnosticos haviam sido inconclusivos. Portanto, a ultrasonografia, alem de util no diagnostico e seguimento da D.R.P.A., pode ser importante no estadiamento, fornecendo subsidios importantes ao tratamento da doenca

Levantamento quantitativo de microrganismos solubilizadores de fosfatos na rizosfera de gramíneas e leguminosas forrageiras na Amazônia

Summary After choosing a selective enrichment medium suitable for most phosphate solubilizing microorganisms, a quantitative survey of these was made in the rhizosphere of: Brachiaria decumbens, B. humidicola. Andropogon gayanus, Paspalum plicatum, Hyparrhenia rufa, Panicum maximum, Desmodium ovalifolium, Pueraria phaseoloides, Zornia sp., Stylosanthes capitata, S. guianensis (CIAT 136). and S. guianensis (IKE 1022, with and without fertilisers. The largest numbers of phosphate solubilizing bacteria (above 1 x 107/g rhizosphere) occurred in the rhizosphere of the leguminous species a nd small numbers (Belw 1 x 107/g rhizosphere) in grasses without fertilisers, except H. rufa and P. maximum. From all the fodder plants analysed, Zornia sp. (Leguminosae) with fertilizer, had the greatest number as phosphate solubilizers. The total number of microorganisms was greater in the treatments without fertilizer in all grasses analysed; but for the leguminous species it was greater for treatments with fertilizer except in S. capitata. Phosphore solubilizing fungi were not considered in this study because they present only in small numbers.

Resumo Após a escolha de um meio de enriquecimento seletivo a um maior número de microrganismos solubilizadores de fosfatos, foi feito um levantamento quantitativo dessas bactérias na rizosfera de Brachiaria decumbens, B. humidicola; Andropogon gayanus, Paspalum plicatum, Hyparrhenia rufa, Panicum maximum, Desmodium ovalifolium, Pueraria phaseoloides, Zornia sp. Stylosanthes capitata, S. guianensis (ClAT 136) e S. guianensis (IRI 1022), adubadas e não adubadas. De um modo geral, números maiores de bactérias solubilizadoras de fosfatos (superior a 1 x 107/g rizosfera) ocorreram na rizosfera de leguminosas. adubadas e não adubadas, e os números mais baixos nas gramíneas (inferior a 1 x 107/g rizosfera). com exceção de H. rufa e P. maximum, sem adubação. De todas as forrageiras analisadas, a rizosfera de Zornia sp. adubada, foi a que melhor se apresentou tanto em número quanto em porcentagem de bactérias solubilizadoras. O número total de microrganismos foi maior nos tratamentos não adubados para todas as gramíneas analisadas e maior nos tratamentos adubados para todas as leguminosas com exceção de S. capitata. Os fungos solubilizadores de fosfatos, não foram considerados, uma vez que estavam presentes em quantidades bem pequenas.