Low Testosterone Levels and Metabolic Syndrome in Aging Male.

Advances in medicine and progressive improvements in the health of the general population in developed countries have led to considerable increases in life expectancy over recent years. Metabolic syndrome (MetS) affects approximately 25% of the adult population and its prevalence is increasing all over the world. Central obesity plays an important role in emergence of MetS. Some studies have suggested that there may be link between low Total Testosterone levels and emergence of MetS. The objective of this review is to analyze the complex network of interactions between MetS and low testosterone levels in elderly men, considering etiologic, diagnostic, and therapeutic aspects. Recent evidence confirms that central obesity is the independent MetS component correlated to Total Testosterone Levels. Experimental studies suggest a two way road between Low Testosterone Levels and abdominal obesity. Besides that, Testosterone Replacement Therapy should be restricted to men with biochemical and clinical features of late onset hypogonadism.

Impacto da insuficiência renal crônica na eficácia de stents farmacológicos: estudo de seguimento de longo prazo / Impact of chronic kidney disease on the efficacy of drug-eluting stents: long-term follow-up study / Impacto de la insuficiencia renal crónica en la eficacia de Stents farmacológicos: estudio de seguimiento de largo plazo

FUNDAMENTO: Pacientes com Insuficiência Renal Crônica (IRC) submetidos à angioplastia coronária apresentam maiores taxas de revascularização da lesão alvo (RLA) e mortalidade. Os stents farmacológicos (SF) estão associados com taxas menores de reestenose, quando comparados aos stents não farmacológicos (SNF), embora em pacientes com IRC os dados da eficácia e segurança do SF sejam limitados. OBJETIVO: Buscamos avaliar a segurança e eficácia dos SF em pacientes com IRC significante, quando comparados a pacientes com função renal normal em um registro da "vida real". MÉTODOS: 504 pacientes submetidos à intervenção coronariana percutânea com SF em dois centros foram incluídos. Os desfechos foram estratificados baseados na presença de IRC, definida como taxa de filtração glomerular basal < 60 ml/min/1,73 m². RESULTADOS: O acompanhamento médio foi de 22,7 meses. A IRC estava presente em 165 pacientes (32,7 por cento). Pacientes com IRC eram mais velhos, tinham mais hipertensão e diabete. Pacientes com IRC apresentaram maior incidência de morte (12,3 por cento vs 2,4 por cento, p < 0,001) e infarto do miocárdio (IM) (7,4 por cento vs 3,3 por cento, p = 0,04), quando comparados aos pacientes sem IRC. Taxas de RLA foram similares entre os grupos (4.8 por cento vs 5.6 por cento, p = 0,7, pacientes com e sem IRC, respectivamente). Preditores independentes de morte foram a IRC (HR 6,93; 2,4 - 19,5, p < 0,001), tabagismo atual (HR 3,66; 1,20 - 11,10, p = 0,02) e diabete (HR 2,66; 1,3 - 6,60, p = 0,045). CONCLUSÃO: Neste registro, a intervenção coronariana com SF em pacientes com IRC foi associada com RLA similar comparada aos pacientes sem IRC, demonstrando a eficácia dos FS na prevenção da reestenose intra-stent nessa população de pacientes. A IRC foi relacionada a um aumento significativo das taxas de IM e mortalidade.

BACKGROUND: Patients with chronic kidney disease (CKD) submitted to coronary angioplasty have higher rates of target lesion revascularization (TLR) and mortality. Drug-eluting stents (DES) are associated with a lower rate of restenosis, compared to bare metal stents (BMS), although data on DES efficacy and safety is limited in patients with CKD. OBJECTIVE: We sought to evaluate the safety and efficacy of DES in patients with significant CKD as compared to patients without normal renal function in a real world registry. METHODS: 504 patients who underwent percutaneous coronary intervention with DES in two centers were included. Outcomes were stratified based on the presence of CKD, defined as a baseline glomerular filtration rate (GFR) < 60 ml/min/1.73 m². RESULTS: The mean follow-up was 22.7 months. CKD was present in 165 patients (32.7 percent). Patients with CKD were older, had a higher incidence of hypertension and diabetes. CKD patients presented an increased incidence of death (12.3 percent vs 2.4 percent, p < 0.001) and myocardial infarction (MI) (7.4 percent vs 3.3 percent, p = 0.04) compared to patients without CKD. TLR rates were similar between groups (4.8 percent vs 5.6 percent, p = 0.7, CKD and no CKD patients, respectively). Independent predictors of death were CKD (HR 6.93; 2.4 - 19.5, p < 0.001), current smoking (HR 3.66; 1.20 - 11.10, p = 0.02) and diabetes (HR 2.66; 1.03 - 6.60, p = 0.045). CONCLUSION: In this registry, coronary intervention with DES in patients with CKD was associated with similar TLR compared to patients without CKD, demonstrating the efficacy of DES in preventing in-stent restenosis in this patient population. CKD was related to significantly increased MI and mortality rates.

FUNDAMENTO: Pacientes con Insuficiencia Renal Crónica (IRC) sometidos a angioplastia coronaria presentan mayores tasas de revascularización de la lesión blanco (RLB) y mortalidad. Los stents farmacológicos (SF) están asociados con tasas menores de reestenosis, cuando son comparados a los stents no farmacológicos (SNF), aunque en pacientes con IRC los datos de la eficacia y seguridad del SF sean limitados. OBJETIVO: Buscamos evaluar la seguridad y eficacia de los SF en pacientes con IRC significativa, cuando fueron comparados a pacientes con función renal normal en un registro de la "vida real". MÉTODOS: 504 pacientes sometidos a intervención coronaria percutánea con SF en dos centros fueron incluidos. Los desenlaces fueron estratificados basados en la presencia de IRC, definida como tasa de filtración glomerular basal < 60 ml/min/1,73 m². RESULTADOS: El control medio fue de 22,7 meses. La IRC estaba presente en 165 pacientes (32,7 por ciento). Pacientes con IRC eran de más edad, tenían más hipertensión y diabetes. Pacientes con IRC presentaron mayor incidencia de muerte (12,3 por ciento vs 2,4 por ciento, p < 0,001) e infarto de miocardio (IM) (7,4 por ciento vs 3,3 por ciento, p = 0,04), cuando fueron comparados a los pacientes sin IRC. Tasas de RLB fueron similares entre los grupos (4.8 por ciento vs 5.6 por ciento, p = 0,7, pacientes con y sin IRC, respectivamente). Predictores independientes de muerte fueron la IRC (HR 6,93; 2,4 - 19,5, p < 0,001), tabaquismo actual (HR 3,66; 1,20 - 11,10, p = 0,02) y diabetes (HR 2,66; 1,3 - 6,60, p = 0,045). CONCLUSIÓN: En este registro, la intervención coronaria con SF en pacientes con IRC fue asociada con RLB similar comparada a los pacientes sin IRC, demostrando la eficacia de los FS en la prevención de la reestenosis intra stent en esa población de pacientes. La IRC fue relacionada a un aumento significativo de las tasas de IM y mortalidad. (Arq Bras Cardiol 2011;96(5):346-352).

Impact of chronic kidney disease on the efficacy of drug-eluting stents: long-term follow-up study.

BACKGROUND: Patients with chronic kidney disease (CKD) submitted to coronary angioplasty have higher rates of target lesion revascularization (TLR) and mortality. Drug-eluting stents (DES) are associated with a lower rate of restenosis, compared to bare metal stents (BMS), although data on DES efficacy and safety is limited in patients with CKD. OBJECTIVE: We sought to evaluate the safety and efficacy of DES in patients with significant CKD as compared to patients without normal renal function in a real world registry. METHODS: 504 patients who underwent percutaneous coronary intervention with DES in two centers were included. Outcomes were stratified based on the presence of CKD, defined as a baseline glomerular filtration rate (GFR) < 60 ml/min/1.73 m². RESULTS: The mean follow-up was 22.7 months. CKD was present in 165 patients (32.7%). Patients with CKD were older, had a higher incidence of hypertension and diabetes. CKD patients presented an increased incidence of death (12.3% vs 2.4%, p < 0.001) and myocardial infarction (MI) (7.4% vs 3.3%, p = 0.04) compared to patients without CKD. TLR rates were similar between groups (4.8% vs 5.6%, p = 0.7, CKD and no CKD patients, respectively). Independent predictors of death were CKD (HR 6.93; 2.4 - 19.5, p < 0.001), current smoking (HR 3.66; 1.20 - 11.10, p = 0.02) and diabetes (HR 2.66; 1.03 - 6.60, p = 0.045). CONCLUSION: In this registry, coronary intervention with DES in patients with CKD was associated with similar TLR compared to patients without CKD, demonstrating the efficacy of DES in preventing in-stent restenosis in this patient population. CKD was related to significantly increased MI and mortality rates.

Contrast-media induced nephropathy in patients undergoing coronary angiography.

Contrast-medium induced nephropathy (CIN) in patients undergoing cardiac catheterization has an extremely variable incidence, which is very elevated in high-risk subgroups. Despite its benign course in most cases, it is associated with a longer hospital stay, and elevated in-hospital and late mortality rates. This paper reviews the physiopathogenesis of CIN, as well as the clinical manifestations and preventive measures currently available.

Remissao da automutilacao em pacientes com transtorno de personalidade borderline durante o tratamento com risperidona: relato de 3 casos / Remission of self-injurious behavior in patientes with borderline personality disorder during risperidone therapy: report of three cases

A automutilacao acompanha diversos quadros psiquiatricos e parece ter diferentes etiologias. Nos pacientes com transtorno de personalidade borderline, ela ocorre em cerca de 80 por cento dos casos, mas pouco se sabe a respeito dos mecanismos envolvidos. Alguns estudos sugerem que esse comportamento esta relacionado a uma disfuncao serotoninergica...

Relaçäo do carcinoma brônquico com tabagismo e sexo: estudo de 570 casos / Evaluating the relation of bronchial carcinoma, tabaccoism and sex

Realizou-se uma análise retrospectiva de prontuários de todos os pacientes submetidos a broncofibroscopia no período de janeiro 1984/maio 1996, com o objetivo de avaliar a correlaçäo do tipo histológico de carcinoma brônquico, a história de tabagismo e o sexo dos pacientes. A idade variou de 35 a 86 anos, com uma média de 61,52 anos; a relaçäo de sexo masculino para sexo feminino foi de 4,63:1, respectivamente; o tipo histológico mais frequente foi o carcinoma do tipo epidermóide (60,4 por cento); a maioria dos pacientes (93,1 por cento) eram fumantes ou ex-fumantes. O carcinoma brônquico é mais prevalente no sexo masculino. Comparando os resultados obtidos neste trabalho com os resultados de outro realizado no mesmo Serviço no período de junho/1977 a maio/1983, observa-se que a relaçäo entre os sexos masculino e feminino diminuiu (era de 6,95:1), mostrando aumento da incidência de carcinoma brônquico entre as mulheres