The biomolecular interactions between endothelium and bone cells: an overview.

Bone turnover is a complex set of different molecules pathways and it is strictly connected with bone vasculature. It includes every bone process concerning bone modelling and remodelling such us skeletal growth and healing process. A fundamental component of this bone architecture is played by the endothelium, that acts in a paracrine fashion on other bone stromal cells via humoral factors, growth factors and chemokines/cytokines. The alteration of those biochemical interactions between endothelium, vasculature and bone tissue may cause various pathological manifestations. Understanding the bases of the interaction between those different pathways could provide novel therapeutic strate¬gies for bone disease. The Authors present an updated overview of the most common communication biomolecules between bone cells and endothelium and their interactions both in healthy and pathological conditions. Furthermore, focusing on gene and related therapies, possible future therapeutic strategies for bone vasculature/metabolic diseases are presented.

Avaliação nutricional e estilo de vida de educadoras de uma creche do município de São Paulo / Nutritional evaluation and life style of educators of a daycare center of thecity of São Paulo / Evaluación nutricional y estilo de vida de educadores de un centro de guardería de la ciudad de São Paulo

A educação alimentar é um componente decisivo para a promoção de saúde, e seu efeito pode ser potencializado quando realizada durante a infância, pois é nessa faixa etária que os hábitos alimentares são formados e consolidados. Para que os resultados da educação alimentar sejam satisfatórios, as educadoras envolvidos precisam estar cientes de seu papel como facilitador desse processo. Esse estudo teve por objetivo avaliar o estado nutricional e de saúde das educadoras de uma creche do município de São Paulo. Foi realizado um estudo transversal descritivo com educadoras de uma creche do município de São Paulo. A coleta dos dados foi realizada porestagiárias de nutrição previamente treinadas. Foram coletadas informações sociodemográficas por meio de uma anamnese alimentar,a fim de avaliar os hábitos alimentares, assim como os dados antropométricos estatura (m), peso (kg) e circunferência da cintura -CC(cm). Participaram da pesquisa 31 educadoras, do gênero feminino, com média de idade 33 anos (± 6,18 dp), não fumantes, a maioria(71%) não consumia bebida alcoólica e não praticava nenhum tipo de atividade física (83,4%). Em relação ao estado nutricional, 51,6% apresentava sobrepeso ou algum grau de obesidade e 45,2% tinha risco para doenças metabólicas segundo a CC. Os resultados indicaram que a maioria das educadoras apresentaram sobrepeso/obesidade, o que reforça a necessidade de implementação de açõesde educação nutricional.

Alimentary education is a decisive component for health promotion, and its effect can be potentiated when carried through during infancy, because this is the stage when alimentary habits are formed and consolidated. For the results of alimentary education tobe adequate, involved educators need to be aware of their role as facilitators of this process. This study aimed to evaluate the nutritional status and general health of t educators of a day-care center of the city of São Paulo. A descriptive transversal study with educators of a day-care center of the city of São Paulo was carried through. Data collection was carried through by trainees of nutrition previouslytrained. Social-demographic information by means of alimentary habits anamneses in order to evaluate their alimentary habits, as wellas anthropometric data: stature (m), weight (kg) and waist circumference - WC (cm). 31 female non smoking educators had participated on the research, with an average age of 33 years (± 6.18 dp), most of them (71%) did not consume alcoholic beverages and did not practice any type of physical activity (83.4%). As regards nutritional status, 51.6% presented overweight or some degree of obesity and 45.2% had risk for metabolic diseases according to WC. The results had indicated that the majority of educators presented overweight/obesity, something that proves the necessity of implementation of nutritional education initiatives.

La educación alimenticia es un componente decisivo para la promoción de la salud, y su efecto puede ser reforzado cuando se ejecuta durante la infancia, porque ésta es la etapa cuando se forman y se consolidan los hábitos alimenticios. Como para los resultados de la educación alimenticia ser adecuados, los educadores implicados necesitan ser conscientes de su función como facilitadores de esteproceso. Este estudio buscó evaluar el estado nutricional y la salud general de los educadores de un centro de guardería de la ciudad de São Paulo. Se ejecutó un estudio transversal descriptivo con los educadores de un centro de guardería de la ciudad de São Paulo. La recolección de datos fue ejecutada por estudiantes de nutrición entrenados previamente. Se recolectaran informaciones sociodemográficas por medio de anamnesis alimenticias de los hábitos para evaluar sus hábitos alimenticios, así como datos antropométricos: estatura (m), peso (kilogramo) y circunferencia de la de la cintura - WC (cm). 31 educadoras no fumadoras han participado en la investigación, conuna media de edad de 33 años (± 6.18 dp), la mayor parte de ellos (el 71%) no consumía bebidas alcohólicas y no practicaban ningún tipo de actividad física (83.4%). En lo que concierne al estado nutricional, 51.6% presentaron exceso de peso o un cierto grado de obesidad y 45.2% tenían riesgo de las enfermedades metabólicas según el WC. Los resultados han indicado que la mayoría de las educadoraspresentaba exceso de peso/obesidad, algo que prueba la necesidad de la puesta en práctica de iniciativas de educación alimenticia.

Surgical technique and haemodynamic changes in adrenalectomy for secreting neoplasia. Personal experience and review of the literature.

BACKGROUND: Laparoscopic adrenalectomy is now used worlwide and is a great advance in laparoscopic technology. The reported benefits of this approach include decreased blood loss, better intraoperative haemodynamic control and shorter hospital stay, however some doubts on its indication for adrenal secreting tumors are still present. The aim of this retrospective study is to compare the physiologic alterations on blood pressure during laparoscopic and laparotomic adrenalectomy in patients with adrenal secreting adenoma, the intraoperative blood loss and mean hospital stay in the 2 groups of patients. A review of the literature is included. METHODS: Laparoscopic adrenalectomy was performed in 13 patients (Conn's syndrome with adrenal adenoma in 10, pheochromocytoma in 3). Laparotomy was used for adrenalectomy in 9 patients: 4 with pheochromocytoma and 5 with Conn's adenoma. All the selected patients in the 2 groups had benign adenoma with tumor size less than 6 cm. During surgery the following data were determined: blood pressure before inducing anaesthesia, pressure peaks, episodes of hypertension and of hypotension, blood loss and operating times. The mean hospital stay was also recorded. RESULTS: No differences were found in the blood-pressure values of the 2 groups of patients. The blood loss was minimal in all but 2 patients. The mean hospital stay was significantly longer in those patients who underwent laparotomy. No significant differences were recorded in the mean operating time. CONCLUSIONS: The 2 techniques seem to have the same physiological consequences in the cardiovascular system, and the operating times for laparoscopic and laparotomic adrenalectomy are not so different. Laparoscopic adrenalectomy is a safe technique to treat small benign adrenal secreting adenomas.

[Our choice of the method to induce pneumoperitoneum in videolaparoscopic surgery]. / La nostra scelta sul metodo di induzione dello pneumoperitoneo in chirurgia videolaparoscopica.

BACKGROUND: In laparoscopic surgery, pneumoperitoneum may be obtained either by a blind or an open access technique. These two techniques and the advantages of Hasson technique are compared. METHODS: Through January 1998 and May 1999, 262 unselected patients underwent laparoscopic surgery; pneumoperitoneum was obtained with a random technique, while in the patients previously operated on the open technique was always performed. In 161 cases (61.5%) pneumoperitoneum was obtained with Hasson technique and in 101 (38.5%) with Veress technique. All the patients were clinically evaluated after surgery and then after 30-40 days. The complications encountered were always associated with the Veress needle blind access: peritoneal space insufflation in 3 cases, greater omentum insufflation in 3 cases, 4 cases of difficult management and only one case of incisional hernia on the umbilical wound. RESULTS: Our data confirm that Hasson open technique is safer than Veress blind technique as the risk of severe early and late complications is lower. CONCLUSIONS: The open laparoscopic technique with the Hasson trocar is recommended as it showed to be a quicker, safer and superior technique for obtaining pneumoperitoneum.

[Transperitoneal anterior access in video-laparoscopic adrenalectomy]. / Accesso anteriore transperitoneale nella surrenalectomia videolaparoscopica.

BACKGROUND: The more wide spread laparoscopic technique to operate on the adrenal gland is transabdominal approach with a lateral flank adrenalectomy. However, the transabdominal anterior approach can be a sure and safe alternative in selected patients. METHODS: From 1997 to 1999, 18 selected patients underwent laparoscopic anterior adrenalectomy. Mean age was 43 years (range 25-63) with a male/female ratio of 1:1. Indications were Conn's adenoma in 10 patients, pheochromocytoma in 3 cases, Cushing syndrome in 1 and incidentaloma in 4. All the procedures were carried out laparoscopically and only one patient required conversion to an open adrenalectomy for clear signs of malignancy. The mean time for adrenalectomy was 140 minutes and the shorter times were recorded in the right-sided procedures (mean time 84 minute). Estimated blood loss was minimal and no transfusion was done. There were no postoperative complications related to the surgical technique and the hospital stay was 4 days in average. RESULTS: Our data confirm, according with other authors, that this method is feasible in selected patients. Longer times recorded for the left-sided lesions were due to the more difficult dissection required to gain the left adrenal gland. CONCLUSIONS: Transabdominal adrenalectomy with patient in the supine position is feasible, but its use is restricted to the cases with suspect bilateral or multifocal pheochromocytoma, to patients with concomitant abdominal pathologies that can be operated on laparoscopically, to surgeons who prefer to have a frontal view of the operative field.

[Incidence hepatitis C virus seroconversion after the implementation of a prevention and control program at a hemodialysis unit]. / Incidência de soroconversão para o vírus da hepatitie C após a implementação de programa de prevenção e controle em unidade de hemodiálise.

This study aimed at reporting the incidence of the hepatitis C virus as well as the prevention and control measures adopted in an hemodialysis unit. It is a prospective study developed with patients attended from September 1996 to December 1998 in an hemodialysis unit. The consultations from September 1996 to December 1996 were considered the control group and the ones from January 1997 to December 1998 the intervention group. Regarding the period of the control group, the routine of the unit was organized based on the regulation 2042 that systematizes the services of renal therapy. In the subsequent period, complementary measures were implemented. From 1997 to 1998, authors observed the reduction in the number of cases of hepatitis C.