ABSTRACT
BACKGROUND: The present study assessed the effects of low-dose acarbose on obese patients with polycystic ovarian syndrome (PCOS). METHODS: A double-blind placebo-controlled study was conducted on 30 obese hyperinsulinaemic women with PCOS treated with 150 mg/day acarbose or placebo for 6 months. The women were evaluated for hirsutism, menstrual regularity, body mass index (BMI), insulin resistance and glucose tolerance, sex hormone-binding globulin (SHBG), LH, FSH, testosterone and androstenedione, and side-effects. RESULTS: The patients in the acarbose group showed a reduction in BMI (35.87 +/- 2.60 versus 33.10 +/- 2.94 kg/m(2)) and in the Ferriman-Gallwey index (8.85 +/- 2.31 versus 8 +/- 1.82), and an increased chance of menstrual regularity (rate = 2.67). SHBG concentration increased (21.01 +/- 7.9 versus 23.85 +/- 7.77 nmol/l) and the free androgen index was reduced (14.81 +/- 9.06 versus 11.48 +/- 6.18). None of these parameters were modified in the placebo group. Mild side-effects occurred in 84% of the patients in the acarbose group and disappeared after the first 3 months. CONCLUSION: A low dose of acarbose administered to obese patients with PCOS promotes a reduction in free androgen index and BMI and an increase in SHBG, with improvement of hirsutism and of the menstrual pattern, and is well tolerated by patients.
Subject(s)
Acarbose/administration & dosage , Hypoglycemic Agents/administration & dosage , Obesity/drug therapy , Polycystic Ovary Syndrome/drug therapy , Administration, Oral , Adult , Body Weight/drug effects , Double-Blind Method , Female , Humans , Hyperandrogenism/drug therapy , Hyperandrogenism/etiology , Hyperinsulinism/drug therapy , Hyperinsulinism/etiology , Obesity/etiology , Placebos , Polycystic Ovary Syndrome/complications , Prospective StudiesABSTRACT
A total of 1147 pertrochanteric and subtrochanteric fractures, 10 delays in consolidation and non-union, 24 pathologic fractures and osteolysis with the risk of fracture, treated with a gamma nail in 17 Italian departments of traumatology, were collected. In 70% of the patients weight-bearing was allowed during the first week postsurgery; 77% of the patients followed-up recovered the same ability to walk that had preceded trauma. Complications included intraoperative (1.8%) and postoperative (1.1%) diaphyseal fractures, cephalic screw cut out (2.2%), and breakage of the nail (0.4%). There were two cases of infection (0.3%). Most of the complications were related to errors in technique. The safest procedure is constituted by the choice of a nail with a thinner caliber, 2 mm diaphyseal over-reaming, insertion of the nail without the use of a hammer, and distal locking; the cephalic screw must always be inserted in the lower portion of the femoral head.
Subject(s)
Bone Nails , Hip Fractures/surgery , Adult , Aged , Aged, 80 and over , Female , Follow-Up Studies , Fracture Fixation, Intramedullary/instrumentation , Fracture Fixation, Intramedullary/statistics & numerical data , Fractures, Spontaneous/complications , Fractures, Spontaneous/diagnostic imaging , Fractures, Spontaneous/surgery , Fractures, Ununited/complications , Fractures, Ununited/diagnostic imaging , Fractures, Ununited/surgery , Hip Fractures/complications , Hip Fractures/diagnostic imaging , Humans , Incidence , Intraoperative Complications/epidemiology , Italy/epidemiology , Male , Middle Aged , Postoperative Complications/epidemiology , Radiography , Time FactorsABSTRACT
In a multicentric study, the data of 628 trochanteric fractures, two non-unions, and 18 pathologic or impending fractures treated by Gamma nail in 13 Italian traumatology services were collected and analyzed. In 70% of the patients weight bearing was allowed in the first postoperative week and 78% of the controlled patients returned to their pretrauma walking ability. Complications included intraoperative (1.4%) and postoperative (1.2%) shaft fractures, "cut out" of the lag screw (2.6%), and nail failure (0.5%). There were no cases of infection. An analysis of complications showed that most of them were due to technical mistakes. The safest procedure is 2 mm diaphyseal overreaming, introduction of the nail without hammering, and distal locking; the lag screw should be placed in the lower part of the head of the femur.
Subject(s)
Bone Nails , Hip Fractures/surgery , Aged , Bone Screws , Female , Hip Fractures/diagnostic imaging , Hip Fractures/rehabilitation , Humans , Male , Middle Aged , Postoperative Complications/etiology , Prosthesis Failure , Radiography , Weight-BearingSubject(s)
Bone Transplantation , Fracture Fixation, Internal/methods , Fractures, Bone/surgery , Pseudarthrosis/surgery , Bacterial Infections/etiology , Bone Plates , Evaluation Studies as Topic , Fractures, Bone/diagnostic imaging , Humans , Humeral Fractures/surgery , Radiography , Tibial Fractures/surgery , Transplantation, IsogeneicABSTRACT
Comparamos os resultados obtidos em testes pos-coito (TPC) realizados em 21 clientes, variando-se o intervalo coito-colheita. No primeiro grupo, o tempo foi de duas a quatro horas, sendo aumentado para oito a 12 horas no segundo grupo. Os testes foram realizados em dois ciclos sucessivos.Podemos observar melhores resultados (testes "bom" e "excelente") com o intervalo menor (47,3%). Quando o tempo coito-colheita aumentou, os resultados pioraram (19,0%). Apesar disso, houve uma melhora de 23,8% nos resultados iniciais, quando examinados em conjunto com os do segundo grupo.Apesar dos inumeros parametros capazes de influir nos resultados do TPC seria logico variar-se o intervalo quando maus resultados indicarem a repeticao do exame
Subject(s)
Humans , Female , Clinical Laboratory Techniques , Coitus , Infertility, Female , Physical ExaminationABSTRACT
Analisamos neste trabalho 163 operacoes realizadas em 160 clientes esteries, com o diagnostico de obstrucao tubaria. O material foi recolhido entre clientes atendidas no Setor de Esterilidade da Divisao de Reproducao humana do Instituto de Ginecologia de UFRJ, de janeiro de 1973 a dezembro de 1981. Os demais fatores de esterilidade foram tidos como normais ou passiveis de correcao. As operacoes realizadas foram de 4 tipos: reimplante uterotubario, salpingostomia, lise de aderencias e anastomose. Verificamos a etiologia das obstrucoes, a propedeutica pre-operatoria e os tipos de operacoes realizadas, correlacionando essa analise com os resultados obtidos quanto a permeabilidade e a gestacao. Os resultados obtidos podem ser assim resumidos: 28 gestacoes (17,18%) das quais temos certeza, 6,13% foram a termo.A permeabilidade obtida foi de 37,4%; no entanto, apenas 101 (60,4%) clientes voltaram para controle. Utilizamos a microcirurgia em 10 casos e o reimplante foi a tecnica com a qual obtivemos melhores resultados
Subject(s)
Adult , Humans , Female , Fallopian Tube Diseases , Hysterosalpingography , Infertility, Female , LaparoscopyABSTRACT
Apresentamos os resultados com a pesquisa efetuada em 31 clientes com carcinoma de vagina, atendidas em 44 anos de funcionamento da instituicao. O estudo comprovou a baixa incidencia da doenca: 0,031% de clientes atendidas e 1,1% em relacao as demais neoplasias diagnosticadas no periodo, assim como a predominancia do tipo epidermoide, acometendo a parede posterior e o terco superior da vagina. O diagnostico precoce e raro, a 5a. e a 6a. decadas da vida sao a epoca de maior incidencia, e as multiparas sao mais sujeitas ao cancer vaginal. O tratamento divide-se entre a histerocolpectomia radical com exenteracao anterior e/ou posterior, ou terapia actinica com radio. cobalto e roentgenterapia.Porem, os resultados mostraram-se invariavelmente precarios, sendo frequente a recidiva e alta a taxa de morbilidade.Apenas 10% das clientes tiveram sobrevivencia de 5 anos, e assim mesmo em mas condicoes fisicas e sociais
Subject(s)
Adult , Middle Aged , Humans , Female , Vaginal NeoplasmsABSTRACT
The authors report a study of 408 cases of exostosis (318 single and 90 multiple) from the records of the Tumour Centre of the Rizzoli Institute. Special attention was paid to the relationship with peripheral chondrosarcoma, 73 cases of which are also in the records of the Institute, and were separately studied. The authors conclude that it is impossible to determine the incidence of malignant transformation of solitary exostosis. The incidence of malignant transformation of multiple exostoses in the present case material was 13 per cent, but the true incidence would undoubtedly be higher if all patients were followed up for life.
Subject(s)
Exostoses/complications , Adolescent , Adult , Bone Neoplasms/etiology , Child , Chondrosarcoma/etiology , Exostoses/genetics , Exostoses/pathology , Female , Humans , Male , RiskABSTRACT
Dezoito pacientes sob quimioterapia antineoplasica, portadoras de carcinoma avancado de ovario ou mama, sao analisados sob o prisma das modificacoes psicologicas causadas pela doenca terminal. Desenvolveu-se, com base nas tecnicas de relacao medico-cliente, um contato mais "real" com a paciente e a familia, buscando integrar essas mulheres proximas da morte com a realidade, entendendo as diversas fases por que passam, segundo Elizabeth Ross.A identificacao das fases de negacao, ressentimento e inveja, compensacao, depressao e aceitacao mostrou-se fundamental para permitir ao medico agir com o maximo de seguranca e serenidade, apesar da natural emergencia de sentimentos de ansiedade e angustia, impossivel de evitar durante o tratamento e o relacionamento com as clientes e seus familiares.A descricao de certas situacoes clinicas ilustram algumas das fases tipicas da evolucao dessas doentes terminais
