[Uremic arteriopathy and ischemic skin changes]. / Urämische Arteriopathie und ischämische Hautveränderungen.

The syndrome of uremic arteriopathy with ischemic skin manifestations--livedo reticularis, skin infarction and ulcerative necrosis--is described in a series of 6 patients. In all patients (3 female and 3 male, age 53-73 years) the syndrome occurred after slowly progressive renal failure and in 5 cases during temporary exacerbation of chronic renal failure and after alkalinizing treatment for marked metabolic acidosis. All patients had evidence of secondary hyperparathyroidism. In 4 the Ca X P product was in excess of 4.90, but only once above the critical product of 5.60 (greater than 70 when conventional units are used). Diagnosis was based on the clinical appearance of the skin involvement and the finding of vascular calcifications (x-ray and skin biopsy). The secondary hyperparathyroidism appears to play an important role in the pathogenesis of the syndrome. An increase in plasma phosphate or Ca X P product, calciphylaxis and/or alkalinizing therapy may release the precipitation of calcium salts in the interstitium or in the vessel walls. Therapy is confined to decreasing plasma phosphate and therewith the Ca X P product by means of phosphate binders or a diet low in phosphate. The unpredictable, often rapid success of parathyroidectomy awaits further clarification.

[Teenage pregnancy. Pt. 1. Contraception and sexuality behavior (author's transl)]. / Gravidez na adolescencia. pt 1. conduta frente a anticoncepcao e ao sexo.

PIP: 122 adolescents of average age 16.3 who delivered their first baby at the Medical School of Campinas, Brazil, were surveyed through a questionnaire devised for the purpose, to investigate their contraceptive knowledge and sexual behavior. 64% of girls declared they wanted to become pregnant; 45.9% did not; 91% knew about contraceptive practices, especially the pill, but only 11.5% of them had used a method. The main reason not to use contraception was fear of side effects. After delivery 64% wanted to use contraception, and 23.7% did not. 57.7% of girls had had their first sexual relation at age 15 or earlier, and 29.5% had had their first period at age 13. About half stated to enjoy sexual relations, but most had diminished the frequency of sexual contacts during pregnancy for fear of hurting the fetus; some had stoppped enjoying sex during pregnancy. This study reveals that most adolescents needed to be educated about sex and related problems, especially contraception; specific plans should be studied and implemented to serve this particular category of patients.^ieng