Estanozolol como anabólico: una causa de hepatotoxicidad / Estanozol as anabolic: a cause of hepatotoxicity / Estanozolol Como Anabólico: Uma Causa De Hepatotoxicidade

Los antibióticos y analgésicos han sido descritos frecuentemente como las principales causas de toxicidad hepática. Los esteroides anabólicos se han relacionado también con alteraciones en sistemas como el cardiovascular o el hepático; en este último causan colestasis, carcinoma hepatocelular, hiperplasia regenerativa nodular y sangrado de varices, secundario a hipertensión portal. Es importante entonces considerar los esteroides anabólicos como factores de riesgo para hepatotoxicidad. Se presenta el primer caso en Colombia y uno de los pocos en Latinoamérica, de colestasis asociada únicamente al uso de estanozolol. Se trata de un paciente de 21 años, en tratamiento con el medicamento para incrementar la masa muscular, que presentó compromiso hepático de tipo colestásico. Se descartaron otras posibles causas de ictericia, mediante la escala CIOMS/RUCAM se llegó a establecer causalidad entre el consumo de estanozolol y la colestasis. El objetivo de este reporte es hacer una descripción no reportada en la literatura colombiana y poco común en la literatura mundial.

Antibiotics and pain relievers have been frequently described as the main causes of liver toxicity. Anabolic steroids have also been linked to alterations in systems such as cardio-vascular or liver. In the latter, they seem to cause cholestasis, hepatocellular carcinoma, nodular regenerative hyperplasia and variceal bleeding secondary to portal hypertension. It is important to consider them as factors associated with hepatotoxicity. The first case in Colombia and one of the few in Latin America of cholestasis associated only to the use of Stanozolol is presented in a 21-year-old patient under treatment with the drug to increase muscle mass. The patient presented with cholestatic liver involvement. Other possible causes of jaundice were ruled out. From the CIOMS / RUCAM scale, causality was established between the consumption of Stanozolol and cholestasis. The objective of this case is to report a case not found in Colombian literature and little reported in world literature.

Antibióticos e analgésicos têm sido frequentemente descritos como as principais causas de toxicidade hepática. Os esteroides anabolizantes também têm sido relacionados a alterações em sistemas como cardiovasculares ou hepáticos; neste último, causam colestase, carcinoma hepatocelular, hiperplasia nodular regenerativa e sangramento varicoso, secundário à hipertensão portal. Portanto, é importante considerar os este-roides anabolizantes como fatores de risco para hepatotoxicidade. O primeiro caso é apresentado na Colômbia e um dos poucos na América Latina, de colestase associada apenas ao uso de estanozolol. Paciente de 21 anos, em tratamento com fármaco para aumento de massa muscular, apresentou acometimento hepático colestático. Outras possíveis causas de icterícia foram descartadas, a escala CIOMS / RUCAM estabeleceu causalidade entre o consumo de estanozolol e colestase. O objetivo deste relatório é fazer uma descrição não relatada na literatura colombiana e rara na literatura mundial

Anabolic steroids and their effects of on neuronal density in cortical areas and hippocampus of mice / Esteroides anabolizantes e seus efeitos na densidade neuronal em áreas corticais e no hipocampo de camundongos

Abstract Anabolic substances have been increasingly used by bodybuilders and athletes with the goal of improving performance and aesthetics. However, this practice has caused some concern to physicians and researchers because of unknowledge of consequences that the indiscriminate and illicit use of these substances can cause. Thus, this study analyzed the effects of two commercially available anabolic steroids (AS), Winstrol Depot® (Stanozolol) and Deposteron® (Testosterone Cypionate), in the neuronal density of limbic, motor and sensory regions on the cerebral cortex and in CA1, CA2, CA3 regions of the hippocampus. A total of 60 Swiss mice were used (30 males and 30 females), separated into three groups: control and two experimental groups, which received the AAS. From each brain, homotypic and semi-serial samples were taken in frontal sections from areas established for the study. The results showed that females treated with testosterone cypionate presented a reduction in all regions tested and the ones treated with Stanozolol showed a decrease in some hippocampal areas. Regarding male animals, stanozolol led to a decrease in neuron number in one hippocampal region. These data allow us to conclude that supra-physiological doses of steroids used in this study, can cause considerable damage to nervous tissue with ultrastructural and consequently behavioral impairment. These changes could interfere with the loss of physical yield and performance of athletes and non-athletes and may cause irreparable damage to individuals making irresponsible use of anabolic steroids.

Resumo As substancias anabólicas tem sido cada vez mais utilizadas por fisiculturistas e atletas com o objetivo de melhorar o desempenho e a estética. No entanto, essa prática tem causado algumas preocupações aos médicos e pesquisadores, devido ao desconhecimento das consequencias que o uso indiscriminado e ilícito dessas substâncias podem causar. Diante disso, este estudo analisou os efeitos de dois esteroides anabolizantes (EA) comercialmente disponíveis, Winstrol Depot® (Stanozolol) e Deposteron® (cipionato de testosterona), na densidade neuronal das regiões corticais límbica, motora e sensitive bem como das áreas CA1, CA2, CA3 do hipocampo. Foram utilizados 60 camundongos Swiss (30 machos e 30 fêmeas), separados em três grupos: controle e dois grupos experimentais, que receberam o EA. De cada cérebro, foram coletadas amostras homotípicas e semi-seriadas em cortes frontais das áreas estabelecidas para o estudo. Os resultados mostraram que as fêmeas tratadas com cipionato de testosterona apresentaram uma redução em todas as regiões analisadas já as fêmeas tratadas com Stanozolol mostraram uma diminuição em algumas áreas do hipocampo. Em relação aos animais machos, o stanozolol levou a uma diminuição na densidade neuronal em uma região do hipocampo. Estes dados nos permitem concluir que doses supra fisiológicas de esteroides utilizadas neste estudo podem causar danos consideráveis ao tecido nervoso com comprometimento ultraestrutural e consequentemente comportamental. Essas alterações podem interferir na perda de rendimento físico e no desempenho de atletas e não atletas e podem causar danos irreparáveis a indivíduos que fazem uso irresponsável destes EA.

Uso de corticosteroides no tratamento da lesão hepática aguda grave decorrente de anabolizante estanazolol / Use of corticosteroids in the treatment of stanazolol-induce severe acute liver injury

A busca pelo corpo perfeito pode gerar graves consequências para a população que faz uso indiscriminado de substâncias visando a resultados rápidos. O caso relatado se refere a um pa- ciente de 21 anos, do sexo masculino, na cidade de São Paulo (SP), que apresentou quadro de síndrome colestática 15 dias após uso do anabolizante estanazolol para fins estéticos na ativi- dade física, evoluindo com hepatite medicamentosa grave, com aumento de transaminases, hiperrubilinemia às custas de bilirrubina direta e fatores de coagulação, sem resposta satis- fatória ao tratamento de suporte convencional, com melhora significativa após introdução de corticoterapia.

Searching for the perfect body image can cause severe conse- quences to the population using substances indiscriminately to reach results fast. The case reported refers to a male patient, 21 years old, from the city of São Paulo (SP), who developed choles- tatic syndrome 15 days after the use of the steroid Stanazol for aesthetic purposes during physical activity, progressing with se- vere drug-induced hepatitis, transaminases, bilirubin, and coagu- lation factors increase with no satisfactory response to the con- ventional support treatment, and significant improvement after the introduction of corticotherapy.

Ação do estanozolol sobre a histologia renal e hepática em ratos treinados com natação / [Stanozolol action on renal and hepatic histology in swimming trained rats]

No presente estudo, foram analisados os efeitos do estanozolol, associado ou não à atividade física, sobre o hemograma, o peso ponderal, a ingestão líquida e sólida, a urinálise, a expressão do VEGF-A renal e o glicogênio hepático, além da histopatologia hepática e renal em ratos Wistar. Foram utilizados 32 ratos Wistar, machos, jovens, separados em quatro grupos: GC (grupo controle); GCE (grupo controle-exercício); GT (grupo tratamento-esteroide); GTE (grupo tratamento-esteroide-exercício). Os animais dos grupos GT e GTE (n=16) foram submetidos a injeções subcutâneas, cinco dias/semana, durante 30 dias, na concentração de 5mg/kg de estanozolol diluído em 1mL de óleo de gergelim, utilizado como veículo. A natação foi definida como exercício físico. Houve aumento no peso dos animais submetidos ao estanozolol e ao exercício a partir da terceira semana de uso e aumento da excreção urinária a partir da quinta semana; os demais parâmetros da urinálise foram semelhantes entre os grupos. O uso de estanozolol associado ou não à atividade física promoveu redução da expressão do VEGF-A nos rins e do glicogênio hepático, além de alterações histopatológicas nesses órgãos. Quanto à hematologia, houve uma diminuição dos leucócitos no GTE em relação aos grupos GT e GCE. Quanto aos linfócitos, houve um aumento no GT e uma diminuição no GTE, e, em relação ao número de plaquetas, houve diminuição no GTE quando comparado ao GT e ao GCE Assim, conclui-se que estanozolol na dose de 5,0mg/kg causa alterações renais e hepáticas em ratos Wistar, podendo levar à falência dos rins e do fígado.(AU)

The goal of this study was to determine the effect of stanozolol (ST) on kidney and liver of Wistar rats. Thirty-two male animals were divided into the following four groups: control group (CG); Control group-exercise (GCE); Group-steroid treatment (GT); Group treatment-steroid-exercise (GTE). Swimming was defined as exercise. The animals GT and GTE was submitted to subcutaneous injections, five days/week for 30 days, at a concentration of 5mg/kg ST diluted in 1mL/kg of sesame oil. The results showed an increase in weight gain in all animals submitted to ST and exercise from the 3rd week of use and increase in urinary excretion from the 5th week and the other urinalysis parameters were similar. The ST associated or not with physical activity reduced VEGF-A expression in the kidneys and hepatic glycogen, as well as histopathological changes in these organs. Regarding hematology, there was a decrease in leukocytes in the GTE. As for lymphocytes there was an increase in GT and a decrease in GTE, and in relation to the number of platelets, there was a decrease in GTE. In conclusion, the administration of stanozolol at 5.0mg/kg caused a structural change of kidney and liver in treated animals.(AU)

Stanozolol promotes osteogenic gene expression and apposition of bone mineral in vitro

Abstract Stanozolol (ST) is a synthetic androgen with high anabolic potential. Although it is known that androgens play a positive role in bone metabolism, ST action on bone cells has not been sufficiently tested to support its clinical use for bone augmentation procedures. Objective: This study aimed to assess the effects of ST on osteogenic activity and gene expression in SaOS-2 cells. Material and Methods: SaOS-2 deposition of mineralizing matrix in response to increasing doses of ST (0-1000 nM) was evaluated through Alizarin Red S and Calcein Green staining techniques at 6, 12 and 24 days. Gene expression of runt-related transcription factor 2 (RUNX2), vitamin D receptor (VDR), osteopontin (SPP1) and osteonectin (ON) was analyzed by RT-PCR. Results: ST significantly influenced SaOS-2 osteogenic activity: stainings showed the presence of rounded calcified nodules, which increased both in number and in size over time and depending on ST dose. RT-PCR highlighted ST modulation of genes related to osteogenic differentiation. Conclusions: This study provided encouraging results, showing ST promoted the osteogenic commitment of SaOS-2 cells. Further studies are required to validate these data in primary osteoblasts and to investigate ST molecular pathway of action.

Oxandrolona no tratamento da lipodermatoesclerose: relato de caso / Oxandrolone for treatment of lipodermatosclerosis: case report

A lipodermatoesclerose é uma paniculite que se caracteriza por endurecimento e hiperpigmentação da pele envolvendo as panturrilhas, com a aparência de "garrafa de champanhe invertida". Muitas abordagens terapêuticas têm sido recomendadas, mas o uso de oxandrolona para essa finalidade foi pouco estudado até o momento. Relatamos um caso de lipodermatoesclerose aguda em uma mulher de 61 anos, com história prévia de tratamento cirúrgico para insuficiência venosa de membros inferiores. A paciente apresentava edema e lesões dolorosas e eritematosas com infiltração difusa, que acometiam principalmente a face posterior da panturrilha esquerda. Foi tratada inicialmente com estanozolol e pentoxifilina, com boa resposta. Devido à indisponibilidade do estanozolol, iniciou-se o uso de oxandrolona. Esse tratamento foi bem tolerado, resultando em redução significativa do edema, do eritema e da infiltração presentes nos membros inferiores, além de alívio da dor. A oxandrolona pode representar uma opção útil e segura no tratamento da lipodermatoesclerose aguda

Lipodermatosclerosis is a panniculitis characterized by hardening and hyperpigmentation of the skin involving the calves with an "inverted champagne bottle" appearance. Many therapeutic approaches have been recommended, but the use of oxandrolone for this purpose has been studied very little to date. We report a case of acute lipodermatosclerosis in a 61-year-old woman with a previous history of surgical treatment for venous insufficiency of the lower limbs. The patient presented with edema and painful, erythematous lesions with diffuse infiltration, mainly affecting the posterior aspect of the left calf. She was initially treated with stanozolol and pentoxifylline, with good response. Due to unavailability of stanozolol, she was put on oxandrolone. This treatment was well tolerated, reduced the intensity of edema, erythema, and infiltration in the lower limbs, effectively leading to pain relief. Oxandrolone may be a useful and safe treatment for patients with acute lipodermatosclerosis

Effect of gonadotropin-releasing hormone analog combined with stanazolol on final height in girls with idiopathic central precocious puberty and apparent decrease of linear growth / 中华儿科杂志

<p><b>OBJECTIVE</b>To evaluate the effect of combined use of stanazolol (ST) on the final adult height (FAH) in girls with idiopathic central precocious puberty (ICPP) and apparently decreased linear growth during gonadotropin-releasing hormone analog (GnRHa) therapy.</p><p><b>METHOD</b>Sixty-three girls with ICPP and decreased velocity of growth of height (HV<4 cm/yr) during GnRHa therapy were divided into 3 groups based on the following types of interventions:group 1 (n = 20), GnRHa+ST [25-30 µg/(kg·d) every 3-month followed by 3-month discontinuation], group 2 (n = 21), GnRHa+recombinant human growth hormone [rhGH, 1-1.1 U/(kg·w)], group 3 (n = 22), GnRHa alone.HV, the advancement of bone age (BA) for chronological age (CA) (ΔBA/ΔCA) and FAH were compared among groups.</p><p><b>RESULT</b>(1)Total duration of ST combination therapy was (12.22 ± 3.62) months, while total duration of combination of rhGH was (13.22 ± 6.80) months. (2)HV increased significantly in both group 1 [ (2.79 ± 0.60) cm/yr vs. (6.27 ± 1.98) cm/yr, P < 0.01] and in group 2 [(2.80 ± 0.50) cm/yr vs. (6.25 ± 1.98) cm/yr, P < 0.01] during combined therapy, but maintained at low levels in group 3 [(3.95 ± 1.10) cm/yr vs. (3.34 ± 0.95) cm/yr, P > 0.05].No significant differences of ΔBA/ΔCA were found among the three groups [0.25(0.11∼0.28), 0.22(0.15∼0.31),0.19(0.10∼0.32), P > 0.05]. (3)FAH was significantly higher than predicted adult height (PAH) before combined therapy, as well as higher than target height (THt) in both group 1 [(156.25 ± 2.90) cm vs. (150.78 ± 3.70) cm, P < 0.01, (156.25 ± 2.90) cm vs. (153.94 ± 2.62) cm, P < 0.01], and in group2 [ (157.33 ± 4.69) cm vs. (152.61 ± 3.92) cm, P < 0.01, (157.33 ± 4.69) cm vs. (154.39 ± 4.72) cm, P = 0.01].In group 3, FAH was similar to PAH [(153.88 ± 2.6) cm vs. (152.54 ± 5.86) cm, P > 0.05], and was less than THt [(153.88 ± 2.6) cm vs. (155.60 ± 4.52) cm, P = 0.02]. (4)In girls treated with ST, no hirsutism, clitorism or hoarse voice was recorded.No polycystic ovary syndrome was found by B-mode ultrasound.</p><p><b>CONCLUSION</b>Intermittent combined use of low dose ST therapy can increase HV and thus improve FAH in girls with ICPP and apparently decreased linear growth during GnRHa therapy.</p>

Histological changes in testes of rats treated with testosterone, nandrolone, and stanozolol

Present study was conducted to observe the effects of testosterone, nandrolone, and stanozolol [forms of AAS] intake during onset of puberty on the rat testicular histology. Juvenile male Sprague-Dawley [SD] rats [n=42] were divided into seven groups and were injected subcutaneously with medium dose of polyethylene glycol-200 [PEG-200] [control], testosterone, nandrolone, and stanozolol for six weeks [PND 41-87]. The animals were weighed daily and sacrificed on PND 88. Testes were removed, weighed, and prepared for histological assessment and finally specimens were observed under microscope. The results showed an insignificant increase in mean daily body weight with highest and lowest body weight gained was of 177.6 +/- 1.69 gr and 140.0 +/- 12.26 gr respectively. There was significant decrease in the testes absolute weight [p

114 children with acquired non-severe aplastic anemia benefitted from androgen / 中国实验血液学杂志

This study was purposed to assess the efficacy of stanozolol for treatment of childhood patients with acquired non-severe aplastic anemia (NSAA). The records of 114 children with acquired NSAA treated in hospital between January 1996 and January 2009 were analyzed retrospectively. All patients received stanozolol with the dose of 0.1 mg/(kg·d). Some patients were treated with supportive care. The incidence and the risk factors of progression severe aplastic anemia (SAA) including gender, age, absolute neutrophil count, absolute reticulocyte count, dependent or independent of transfusion, the ratio of granulocytes and erythrocytes were evaluated. The results indicated that at a median follow-up of 52 months (range 5 - 181), 6 patients (5.3%) progressed into SAA, 93 (81.6%) remained in NSAA, and 15 (13.2%) had complete remission. Patients with dependent of transfusion (platelet count < 10 × 10(9)/L and/or haemoglobin < 70 g/L) have higher risk to progress into SAA (19.2% vs 1.1%) (p = 0.016); patients with lower absolute neutrophil count (ANC) (< 0.8 × 10(9)/L) or with lower absolute reticulocyte count (ARC) (< 40 × 10(9)/L) at diagnosis have higher risk to progress into SAA (8.1% vs 0%) (p = 0.029); (9.1% vs 1.7%) (p = 0.034); Those patients with lower ANC (ANC < 0.8 × 10(9)/L) and lower ARC (ARC < 40 × 10(9)/L) have higher risk into progress to SAA (19.2% vs 1.1%) (p = 0.016). It is concluded that NSAA patients treated with Stanozolol progress into SAA with the rate of 5.3%. Those patients with dependent of transfusion or ANC < 0.8 × 10(9)/L or/and ARC < 40 × 10(9)/L have higher risk of progress into SAA.

Stanozolol activates the cross-talk of estrogen receptor alpha-insulin-like growth factor-1 receptor-extracellular-signal regulated kinase 1/2 in the growth plate chondrocytes of estrogen-inhibited adolescent rats in vitro / 中华儿科杂志

<p><b>OBJECTIVE</b>To investigate the effects and the mechanisms of stanozolol (ST) on the proliferation, maturation and differentiation of in vitro cultured growth plate chondrocyte isolated from gonadotropin releasing hormone analogue (GnRHa)-treated adolescent rats, to study if ST mediates the proliferation of chondrocytes via the estrogen receptor alpha (ERalpha), androgen receptor (AR) and/or insulin-like growth factor-1 receptor (IGF-1R) and interactions of the two receptor and IGF-1R receptor signaling pathway, to investigate the mechanism of the biological effects in ST promoting bone growth/maturity at molecular level.</p><p><b>METHOD</b>The rats were weaned at the end of 3 weeks and intramuscular injection of triptorelin of GnRHa preparations, qow x 2 was started. The rats were sacrificed at the end of 7 weeks, and then the tibiae growth plates were taken out with sterile procedure. The chondrocytes were obtained by two-time enzyme digestion method, and the experiments were carried out with the primary chondrocytes. Immunohistochemical staining of proliferating cell nuclear antigen (PCNA) and Western blot analysis were applied.</p><p><b>RESULT</b>The results of PCNA demonstrated that stanozolol enhanced the proliferation of the chondrocytes, time-course studies showed that the proliferation were maximally stimulated by stanozolol after 2 days of incubation and decreased again after longer periods of incubation. The expression of p-ERalpha, p-IGF-1R and p-extracellular-signal regulated kinase 1/2 (ERK1/2) increased with the incubation period of ST treatment, and reached the peak value at a certain time, and then gradually decreased. The expression of p-ERalpha, p-IGF-1R and p-ERK1/2 increased with the elevation of ST concentration, and reached the peak value at 10(-9) - 10(-8) mol/L, then gradually decreased. ST induced-p-ERalpha expression was partially blocked by ERalpha and mitogen-activated protein kinase kinase inhibitors. ST induced-p-IGF-1R expression was partially blocked by ERalpha and IGF-1R inhibitors. ST induced-p-ERK1/2 expression was partially blocked by mitogen-activated protein kinase kinase and IGF-1R inhibitors.</p><p><b>CONCLUSION</b>As an androgen derivation, ST exerts its biological effects of promoting proliferation of the long bone growth plate chondrocytes via activating the classic ERalpha receptor pathway and mitogen-activated protein kinase pathway, and at the same time, by activation of IGF-1R. Both IGF-1R and ERalpha can promote "cross-talk" of two systems' receptor signal through mitogen-activated protein kinase signal pathway.</p>

Effect of treatment for myelodysplastic syndrome by Qinghuang Powder combined with Chinese herbs for reinforcing shen and strenghening pi / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To observe the clinical efficacy of Qinghuang Powder combined with Chinese herbs for reinforcing Shen and strenghening Pi in treating myelodysplastic syndrome (MDS).</p><p><b>METHODS</b>fifty-five patients with diagnosis fitting to MDS were treated with Qinghuang Powder and decoction for strengthening Pi and reinforcing Shen, in combination with Stanozololum.</p><p><b>RESULTS</b>Eleven patients (20.0%) out of the 55 were completely remitted (CR), the total effective rate being 74.5% (41/55 cases). By FAB typing, 9 (26. 5%) in the 34 patients of type RA/RAS were CR, with the total effective rate of 82.4% (28/34 cases), and in the 21 patients of type RAEB, 9.5% (2/21 cases) were CR with the total effective rate of 61.9% (13/21 cases), showing insignificant statistical difference between the two types (P > 0.05). By international prognostic scoring system (IPSS), the treatment was evaluated as CR in 10 patients, effective in 25 and ineffective in 11 in 36 patients of moderate risk group I , the responding numbers were 1, 4, 2 in 7 patients of moderate risk group II and 0, 3, 3 in 6 patients of high risk group, respectively, also showing insignificant difference between groups (P > 0.05). Levels of Hb, WBC and platelet significantly increased after treatment (P < 0. 05). By cytogenetics, the effective rate was 68.8% (11/16 cases) in patients with abnormal chromosome and 72.7% (24/33 cases) in those with normal chromosome, with insignificant difference (P > 0.05).</p><p><b>CONCLUSION</b>The comprehensive therapy with TCM treatment for reinforcing Shen and dissolving stasis in dominance has a definite clinical effect in treating MDS, it was not significantly associated with FAB typing, IPSS score, and chromosome abnormality of patients.</p>

Prevalência do uso de agentes anabólicos em praticantes de musculação de Porto Alegre / Prevalence of the use of anabolic agents among strength training apprentices in Porto Alegre, RS

Este estudo procura determinar, através de questionário realizado por entrevistadores, a prevalência do uso atual ou passado de esteróides anabólicos androgênicos (EAA), outros hormônios (OH), outros medicamentos (OM) e outras substâncias (suplementos alimentares e drogas ilícitas) em praticantes de musculação da cidade de Porto Alegre, entrevistando 288 indivíduos sorteados de uma amostra de 13 academias. A prevalência observada foi de 11,1 por cento (32/288) para EAA, 5,2 por cento (16/288) para OH e 4,2 por cento (12/288) para OM. Os EAA mais usados foram decanoato de nandrolona e estanozolol. Os OH foram gonadotrofina coriônica humana, triiodotironina e OM como lipostabil, diuréticos e medicamentos veterinários (ex.: Monovin E). Os efeitos colaterais mais freqüentes foram comportamentais (variação de humor, irritabilidade e agressividade) e endócrinos (acne e aumento/ diminuição da libido). Quando analisados os EAA juntamente aos OH na variável denominada "agentes hormonais" (AH), observamos diferença estatística (p< 0,05) entre os sexos, sendo o uso de AH mais prevalente em homens e entre os consumidores de suplementos alimentares. Comparar este estudo a outros é difícil, pois existe diferença no desenho epidemiológico. Entretanto, a alta prevalência observada sugere a necessidade de medidas preventivas, educativas e de cuidados na assistência desta população.

This study aimed to determine through a questionnaire applied to interviewers, the current or past use of anabolic androgenic steroids (AAS), as well as other hormones (OH), and other medicines (OM), food supplement and illicit drugs among strength training apprentices in the city of Porto Alegre, RS. We interviewed 288 subjects draw from a sample of 13 gyms. The prevalence of current and past use of AAS was about 11.1 percent (32/288), OH 5.2 percent (16/288) and OM 4.2 percent (12/288). The most used AAS were nandrolone and stanozolol; the OH were gonadotropin, triiodothyronine (T3) and OM, like lipostabil, diuretics and veterinary medicines (Monovin E). The most frequent side-effects were behavioral such as humor oscillation, irritability and hostility, and endocrine disturbances such as acne and increased or decreased libido. When analyzed together with other hormones in a variable named "hormonal agents" (AH), AAS presented a statistical difference (p< 0.05) among genders considering that the most frequent use of AH occurred among men and those who consume food supplements. The comparison of these findings to other national and international results is difficult due to the epidemiological design. Even if it is considered, the observed prevalence suggests that preventive attitudes as well as special care in the orientation and education of this population must be taken.

Clinical observation on treatment of chronic aplastic anemia by Shengxuening and cyclosporin A / 中国结合医学杂志

<p><b>OBJECTIVE</b>To explore the therapy to further elevate the efficacy of the treatment of chronic aplastic anemia (CAA).</p><p><b>METHODS</b>Forty-five patients with CCA were assigned into two groups, the 26 patients in the treated group were treated by Shengxuening (a Chinese herbal preparation) and cyclosporin A (CsA), and the 19 patients in the control group were treated with androgen alone, with the therapeutic course lasting for over 3 months. Changes of peripheral blood picture, and the colony productivity of burst forming unit-erythroid (BFU-E), colony forming unit-erythroid (CFU-E) and colony forming unit-granulocyte macrophage (CFU-GM) in bone marrow were observed before and after 3 months treatment. The amount of erythrocyte and platelet infusion, frequency of infection, condition of hemorrhage and relevant death were also observed. The follow-up study was conducted for over half a year.</p><p><b>RESULTS</b>The total effective rate in the treated group was 84.6%, which was significantly higher than that in the control group (52.6%, P < 0.05). Levels of hemoglobin, reticulocyte, neutrophil and platelet increased after treatment in the treated group, as compared with those before treatment, with significant difference (P < 0.05), and the colony productivity of BFU-E, CFU-E and CFU-GM in bone marrow also got significantly increased (P < 0.01), and showed significant difference from those in the control group (P < 0.05).</p><p><b>CONCLUSION</b>Shengxuening-assisting CsA therapy is an effective measure for treatment of CAA.</p>

Acquired angioedema secondary to hormone replacement therapy.

Angioedema is a potentially life threatening condition and may be either inherited or acquired. The latter is rare with only a handful of cases reported in the world literature. Presenting complaints are often vague. Those most commonly described include swelling in the subcutaneous and submucosal tissues. Patients presenting with laryngeal edema have high mortality, and high clinical suspicion is necessary to avoid instrumentation, which can precipitate laryngeal spasm. We present a review of reported cases of hormonally induced hereditary angioedema, along with a report of a patient with acquired angioedema secondary to hormone replacement therapy. To the best of our knowledge, this case probably represents the first reported case of acquired angioedema secondary to hormone replacement therapy.

Influence of Shenmai injection on blood serum tumor necrosis factor and bone marrow CD34+ cell's apoptosis of chronic aplastic anemia patient / 中国中药杂志

<p><b>OBJECTIVE</b>To investigate the effect of Shenmai injection on chronic aplastic anemia patients and its mechanism.</p><p><b>METHOD</b>Sixty-five chronic aplastic anemia patients were randomized into treatment group and control group. The patients of the treatment group were treated by injecting Shenmai injection and taking western medicine orally, those of the control group taking western medicine orally only, then the effect was evaluated. The concentration of tumor necrosis factor-alpha (TNF-alpha) in blood serum was detected and the apoptosis of bone marrow CD34+ cell was analysed by DNA ISEL technic before and after treatment.</p><p><b>RESULT</b>The effective rate of the treatment group and the control group was 63.6 % and 40.6 % respectively, the effect of the Shenmai injection on the treatment group was obviously better than that of the control group (P < 0.01). Before treatment, the concentration of TNF-alpha in blood serum and the apoptosis rate of bone marrow CD34+ cell of the chronic aplastic anemia patient were higher than normal (P < 0.01). After treatment, the concentration of TNF-alpha in blood serum of the treatment group decreased obviously (P < 0.01), and the apoptosis rate of bone marrow CD34+ cell of the treatment group also decreased (P < 0.05), which had significant difference compared with those of the control group (P < 0.05).</p><p><b>CONCLUSION</b>Shenmai injection is efficient to chronic aplastic anemia. The mechanism is decreasing the concentration of TNF-alpha in blood serum and the apoptosis rate of bone marrow CD34+ cell.</p>

Clinical efficacy and T-lymphocyte subset, serum interferon-gamma (IFN-gamma), tumor necrosis factor-alpha (TNF-alpha), interleukin-2(IL-2) levels on treatment of chronic aplastic anemia patients by shenfu injection combined with stanozol and cyclosporin A / 中国中药杂志

<p><b>OBJECTIVE</b>To observe the effect of Shenfu injection (SFI) and influence on T-lymphocyte subset, serum level of interferon-gamma(IFN-gamma), tumor necrosis factor-alpha(TNF-alpha), interleukin-2(IL-2) in patients with chronic aplastic anemia (CAA) based on treating with stanozol and cyclosporin A.</p><p><b>METHOD</b>60 patients with CAA were randomly divided into two groups, 30 patients in the SFI group were treated with SFI (100 mL which contains Ginsenoside 0.8 mg x mL(-1) and aconitine 1.8 microg x mL(-1) by adding it in 500 mL of 5% glucose every day) plus stanozol and cyclosporin A and 30 patients in the control group treated with slanozol and cyclosporin A alone for 2 months. The clinical efficacy was observed. The change of T-lymphocyte subset analyzed by flow cytometry and the levels of serum IFN-gamma, TNF-alpha, IL-2 measured with ELISA method were also observed before and after treatment.</p><p><b>RESULT</b>After treatment, the total effective rate of the SFI group was higher than that in the control group, but it did not showing significant difference. The CD4/CD8 levels were significantly increased (1.76+/-0.49, P< 0.01) and CD8 levels were significantly lowered (22.57+/-6.30, P < 0.01) in the SFI group after treatment. Serum levels of lFN-gamma, TNF-alpha and IL-2 were lower in both groups, and the level of TNF-alpha and IL-2 in the SFI group (0.710+/-0.213) ng x L(-1) and (0.639+/-0.247) ng x L(-1) was significantly lowered than that in the control group (P < 0.05, P < 0.01).</p><p><b>CONCLUSION</b>SFI might believe the hemopoietic inhibition so as to promote the recovery of hemopoietic function through improving the T-lymphocyte subset and reducing the release of hemopoietic negative regulatory factors such as IFN-gamma, TNF-alpha and IL-2.</p>

Clinical report on treatment of 7 patients with refractory anemia by using cyclosporin A / 中国实验血液学杂志

To explore the treatment of refractory anemia (RA), 7 cases of myelodysplastic syndrome (subtype of refractory anemia) were treated in combination of cyclosporin A (CsA) with stanozolol. Duration of treatment with CsA was 5 months-3 years (mean 13 months). The results showed that among 7 cases 6 were effective, 1 case no responded to treatment. 3 cases out of 6 effective cases achieved complete remission without transfusion dependence, 1 cases achieved partial remission, 2 cases were improved. During the investigation signs of leukemia ot other malignant tumors not were found in all cases. In conclusion, CsA treatment is effective for part cases of RA, side effects of drugs are tolerable for patients.

Uso de esteróides anabólicos androgênicos por praticantes de musculação de grandes academias da cidade de São Paulo / Use of anabolic-androgenic steroids among body builders in major gym centers in São Paulo, Brazil

O objetivo desta pesquisa foi estimar o consumo e traçar o perfil dos usuários de esteróides anabólicos androgênicos (EAA) entre praticantes de musculação em três grandes academias de ginástica na cidade de São Paulo. Foi utilizado um questionário estruturado para ser respondido voluntária e anonimamente, com garantia explícita de confidencialidade para os mesmos. Os questionários ficaram disponíveis em três academias por uma semana, após ter sido feita ampla divulgação dos objetivos e importância do projeto. Responderam o questionário 209 praticantes de musculação (cerca de 3 por cento do total). A incidência de uso de EAA foi de 19 por cento, sendo que, destes, 8 por cento declararam que fazem uso atualmente e 11 por cento, que já haviam feito uso anteriormente; considerando apenas o sexomasculino, a incidência do uso foi de 24 por cento...

Low dose cyclosporine-a therapy in severe aplastic anaemia.

OBJECTIVE: The present study was conducted to evaluate the efficacy of low dose cyclosporine-A in the patients of severe aplastic anaemia, who cannot afford allogenic bone marrow transplantation and immunosuppressive therapy with antithymocyte globulin. METHODS: The diagnosis of severe aplastic anaemia was established by standard criteria. Twelve patients were given cyclosporine-A orally at a dose of 6 mg/kg body weight in divided doses in two daily equal proportions for six months. Eleven patients were put on oral stanozolol in the dosage of 1 mg/kg body weight/day in divided doses. All surviving patients were evaluated at three and six months. RESULTS: At the end of six months, 41.66% of twelve patients responded to cyclosporine-A. One patient had complete response and four patients had partial response. Only one out of 11 patients receiving stanozolol responded. CONCLUSIONS: i) Cyclosporine-A is a viable therapeutic option in the treatment of severe aplastic anaemia, ii) Low dose cyclosporine-A is able to slow down the stormy course of the severe aplastic anaemia, iii) Androgens have very little effect on the survival of patients of severe aplastic anaemia.

Edema angioneurótico hereditario / Hereditary angioneurotic edema

Se realiza una revisión del tema edema angioneurótico hereditario. Después de una introducción histórica se considera el sistema del complemento, el sistema de las cininas, los inhibidores de las proteasas hemáticas derivadas del plasminógeno y la vinculación entre ambos. Se consideran también los avances últimos en lo que a citogenética molecular se refiere. Se presentan las diferentes formas clínicas de los edemas angioneuróticos hereditarios, así como sus diferencias clínico-laboratoriales. Se hace una valoración de los tratamientos sustitutivos y profilácticos. Se expone el estudio de tres casos clínicos observados en el lapso de 30 años de práctica dermatológica.