Early Markers of Atherosclerotic Disease in Individuals with Excess Weight and Dyslipidemia / Marcadores Precoces de Doença Aterosclerótica em Indivíduos com Excesso de Peso e Dislipidemia

Abstract Background: Excessive weight is a cardiovascular risk factor since it generates a chronic inflammatory process that aggravates the endothelial function. Objective: To evaluate the endothelial function in individuals with excess weight and mild dyslipidemia using brachial artery flow-mediated dilation (BAFMD), and the association of endothelial function with anthropometric and biochemical variables. Methods: Cross-sectional study that included 74 individuals and evaluated anthropometric variables (body mass index [BMI], waist-hip ratio [WHR], waist circumference [AC], and percentage of body fat [PBF]), biochemical (blood glucose, insulinemia, ultrasensitive C-reactive protein, fibrinogen, total cholesterol, HDL-cholesterol, triglycerides, and LDL-cholesterol) and endothelial function (BAFMD, evaluated by ultrasound). The statistical analysis was performed with SPSS, version 16.0. To study the association between the variables, we used chi-square, Student's t and Mann-Whitney tests, and Pearson's correlation. Logistic regression analyzed the independent influence of the factors. Values of p < 0.05 were considered significant. Results: The participants had a mean age of 50.8 years, and 57% were female. BMI, WC, WHR, and PBF showed no significant association with BAFMD. The male gender (p = 0.02) and higher serum levels of fibrinogen (p = 0.02) were significantly and independently associated with a BAFMD below 8%. Conclusions: In individuals with excess weight and mild untreated dyslipidemia, male gender and higher levels of fibrinogen were independently associated with worse BAFMD.

Resumo Fundamento: O excesso de peso é um fator de risco cardiovascular, pois gera um processo inflamatório crônico que agrava a função endotelial. Objetivo: Avaliar a função endotelial de indivíduos com excesso de peso e dislipidemia leve através da dilatação da artéria braquial mediada pelo fluxo (DABMF) e sua associação com variáveis antropométricas e bioquímicas. Métodos: Estudo transversal com inclusão de 74 indivíduos e avaliação de variáveis antropométricas (índice de massa corporal [IMC], razão cintura-quadril [RCQ], circunferência abdominal [CA] e percentual de gordura corporal [PGC]), bioquímicas (glicemia, insulinemia, proteína C reativa ultrassensível, fibrinogênio, colesterol total, HDL-colesterol, triglicerídeos e LDL-colesterol) e função endotelial (DABMF, avaliada por ultrassonografia). A análise estatística foi realizada pelo programa SPSS, versão 16.0. Para estudar a associação entre as variáveis, foram utilizados os testes do qui-quadrado, t de Student, Mann-Whitney e correlação de Pearson. Regressão logística analisou a influência independente dos fatores. Valores de p < 0,05 foram considerados significativos. Resultados: Os participantes tinham uma média de idade de 50,8 anos e 57% eram do gênero feminino. O IMC, a CA, a RCQ e o PGC não mostraram associação significativa com a DABMF. O gênero masculino (p = 0,02) e níveis séricos mais elevados de fibrinogênio (p = 0,02) estiveram significativamente e independentemente associados a uma DABMF inferior a 8%. Conclusões: Em indivíduos com excesso de peso e dislipidemia leve não tratada, o gênero masculino e níveis mais elevados de fibrinogênio foram associados de forma independente com uma pior DABMF.

Early Markers of Atherosclerotic Disease in Individuals with Excess Weight and Dyslipidemia.

BACKGROUND: Excessive weight is a cardiovascular risk factor since it generates a chronic inflammatory process that aggravates the endothelial function. OBJECTIVE: To evaluate the endothelial function in individuals with excess weight and mild dyslipidemia using brachial artery flow-mediated dilation (BAFMD), and the association of endothelial function with anthropometric and biochemical variables. METHODS: Cross-sectional study that included 74 individuals and evaluated anthropometric variables (body mass index [BMI], waist-hip ratio [WHR], waist circumference [AC], and percentage of body fat [PBF]), biochemical (blood glucose, insulinemia, ultrasensitive C-reactive protein, fibrinogen, total cholesterol, HDL-cholesterol, triglycerides, and LDL-cholesterol) and endothelial function (BAFMD, evaluated by ultrasound). The statistical analysis was performed with SPSS, version 16.0. To study the association between the variables, we used chi-square, Student's t and Mann-Whitney tests, and Pearson's correlation. Logistic regression analyzed the independent influence of the factors. Values of p < 0.05 were considered significant. RESULTS: The participants had a mean age of 50.8 years, and 57% were female. BMI, WC, WHR, and PBF showed no significant association with BAFMD. The male gender (p = 0.02) and higher serum levels of fibrinogen (p = 0.02) were significantly and independently associated with a BAFMD below 8%. CONCLUSIONS: In individuals with excess weight and mild untreated dyslipidemia, male gender and higher levels of fibrinogen were independently associated with worse BAFMD.

High-sensitivity C-reactive protein as a predictor of cardiovascular events after ST-elevation myocardial infarction.

BACKGROUND: The association between high-sensitivity C-reactive protein and recurrent major adverse cardiovascular events (MACE) in patients with ST-elevation myocardial infarction who undergo primary percutaneous coronary intervention remains controversial. OBJECTIVE: To investigate the potential association between high-sensitivity C-reactive protein and an increased risk of MACE such as death, heart failure, reinfarction, and new revascularization in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention. METHODS: This prospective cohort study included 300 individuals aged >18 years who were diagnosed with ST-elevation myocardial infarction and underwent primary percutaneous coronary intervention at a tertiary health center. An instrument evaluating clinical variables and the Thrombolysis in Myocardial Infarction (TIMI) and Global Registry of Acute Coronary Events (GRACE) risk scores was used. High-sensitivity C-reactive protein was determined by nephelometry. The patients were followed-up during hospitalization and up to 30 days after infarction for the occurrence of MACE. Student's t, Mann-Whitney, chi-square, and logistic regression tests were used for statistical analyses. P values of ≤0.05 were considered statistically significant. RESULTS: The mean age was 59.76 years, and 69.3% of patients were male. No statistically significant association was observed between high-sensitivity C-reactive protein and recurrent MACE (p = 0.11). However, high-sensitivity C-reactive protein was independently associated with 30-day mortality when adjusted for TIMI [odds ratio (OR), 1.27; 95% confidence interval (CI), 1.07-1.51; p = 0.005] and GRACE (OR, 1.26; 95% CI, 1.06-1.49; p = 0.007) risk scores. CONCLUSION: Although high-sensitivity C-reactive protein was not predictive of combined major cardiovascular events within 30 days after ST-elevation myocardial infarction in patients who underwent primary angioplasty and stent implantation, it was an independent predictor of 30-day mortality.

High-Sensitivity C-Reactive Protein as a Predictor of Cardiovascular Events after ST-Elevation Myocardial Infarction / Proteína C-Reativa Prediz Eventos Cardiovasculares Após Infarto do Miocárdio com Elevação do ST?

Background: The association between high-sensitivity C-reactive protein and recurrent major adverse cardiovascular events (MACE) in patients with ST-elevation myocardial infarction who undergo primary percutaneous coronary intervention remains controversial. Objective: To investigate the potential association between high-sensitivity C-reactive protein and an increased risk of MACE such as death, heart failure, reinfarction, and new revascularization in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention. Methods: This prospective cohort study included 300 individuals aged >18 years who were diagnosed with ST-elevation myocardial infarction and underwent primary percutaneous coronary intervention at a tertiary health center. An instrument evaluating clinical variables and the Thrombolysis in Myocardial Infarction (TIMI) and Global Registry of Acute Coronary Events (GRACE) risk scores was used. High-sensitivity C-reactive protein was determined by nephelometry. The patients were followed-up during hospitalization and up to 30 days after infarction for the occurrence of MACE. Student's t, Mann-Whitney, chi-square, and logistic regression tests were used for statistical analyses. P values of ≤0.05 were considered statistically significant. Results: The mean age was 59.76 years, and 69.3% of patients were male. No statistically significant association was observed between high-sensitivity C-reactive protein and recurrent MACE (p = 0.11). However, high-sensitivity C-reactive protein was independently associated with 30-day mortality when adjusted for TIMI [odds ratio (OR), 1.27; 95% confidence interval (CI), 1.07-1.51; p = 0.005] and GRACE (OR, 1.26; 95% CI, 1.06-1.49; p = 0.007) risk scores. Conclusion: Although high-sensitivity C-reactive protein was not predictive of combined major cardiovascular events within 30 days after ST-elevation myocardial infarction in patients ...

Fundamento: A associação entre proteína C-reativa ultrassensível e eventos cardiovasculares maiores recorrentes em pacientes com infarto agudo do miocárdio com supradesnivelamento do segmento ST submetidos à intervenção coronariana percutânea primária é controversa. Objetivo: Verificar se a proteína C-reativa ultrassensível está associada a risco aumentado de eventos cardiovasculares maiores, como morte, insuficiência cardíaca, reinfarto e nova revascularização, em pacientes com infarto agudo do miocárdio com supradesnivelamento do segmento ST tratados com intervenção coronariana percutânea primária. Métodos: Coorte prospectiva, incluindo 300 indivíduos maiores de 18 anos admitidos em um centro terciário com diagnóstico de infarto agudo do miocárdio com supradesnivelamento do segmento ST submetidos à intervenção coronariana percutânea primária. Utilizou-se instrumento contendo variáveis clínicas e escores de risco TIMI e GRACE, além da proteína C-reativa ultrassensível analisada por nefelometria. Os pacientes foram acompanhados na internação e até 30 dias após o infarto para a ocorrência de eventos cardiovasculares maiores recorrentes. Na análise estatística, foram utilizados os testes t de Student, Mann-Whitney, qui-quadrado e regressão logística. O valor de p ≤ 0,05 foi considerado significativo. Resultados: A média de idade foi de 59,76 anos, sendo 69,3% do gênero masculino. Não houve associação estatisticamente significativa entre proteína C-reativa ultrassensível e eventos cardiovasculares maiores recorrentes (p = 0,11). No entanto, a proteína C-reativa ultrassensível foi associada a óbito em 30 dias, de forma independente, quando ajustada ...

The effect of celecoxib on the development of diethylnitrosamine-induced liver tumors in rats.

BACKGROUND/AIMS: Hepatocellular carcinoma is one of the most commonly diagnosed malignant tumors in the world, and it typically has a poor prognosis. Extensive studies have examined the effects of non-steroidal anti-inflammatory drugs selective to COX-2 on the chemoprevention of various tumors. The objective of this study is to observe the effect of celecoxib on the development of liver tumors in rats. MATERIAL AND METHODS: Hepatocellular carcinoma was induced in a group of 75 rats with the carcinogen diethylnitrosamine. The animals were divided into 5 groups. Three groups received various doses of celecoxib, one group received indomethacin, and a control group received no non-steroidal selective anti inflammatory drugs. RESULTS: The experimental model was considered to be successful because 78% of the rats in the control group developed liver tumors. The number of neoplastic lesions was similar among the celecoxib, indomethacin and control groups, although the nodule diameter of the lesions was smaller in the celecoxib group. Better results were observed in animals that received celecoxib at doses of 6 and 9 mg/kg/ day; 4 rats in these groups did not show any neoplastic histological lesions, and a greater proportion of the nodules in the other animals in these groups were benign than in the groups that did not use celecoxib. CONCLUSIONS: These results suggest that celecoxib may play a role in modifying the natural history of hepatocellular carcinoma development.

Prognostic value of fasting glucose levels in elderly patients with acute coronary syndrome.

BACKGROUND: The fasting plasma glucose (FPG) test is a predictor of complications after Acute Coronary Syndrome (ACS). However, its prognostic value is not yet fully established in different age groups. OBJECTIVE: To evaluate the role of admission fasting plasma glucose (FPG) as a predictor of 30 days after ACS, and the association of hyperglycemia with major cardiovascular events (MACE): death, reinfarction and coronary artery bypass grafting, in two different age groups (<65 year and ≥65 year-old patients). METHODS: Contemporary cohort of patients hospitalized for ACS in the Institute of Cardiology of Rio Grande do Sul (Southern Brazil). In the first 24 hours of admission, patients answered a questionnaire with clinical information and had peripheral blood collected for measurement of FPG. Patients were followed up during hospitalization and for 30 days for the presence of MACE. Statistical analyses were performed using the SPSS 15.0 with the chi-square or Fisher Exact test (categorical variables) and the Student t test (numerical variables). Multivariate analysis was performed. RESULTS: 580 patients were included in the study. Mean age was 61.2 (±12.3) years, with 38.6% of the patients (224) ≥65 years old, and 67.7% (393) were male. Multivariable analysis showed that, after 30 days of follow-up, only FPG (OR= 1.01, 95% CI:1.00-1.01, P= 0.001) was associated with MACE in both age groups. CONCLUSION: Admission FPG was an independent predictor for MACE in the early phase of ACS.

Valor prognóstico da glicemia de jejum em pacientes idosos com síndrome coronariana aguda / Prognostic value of fasting glucose levels in elderly patients with acute coronary syndrome / Valor pronóstico de la glucemia de ayuno en ancianos con síndrome coronario agudo

FUNDAMENTO: O exame da glicose plasmática de jejum (GPJ) é preditor de complicações após Síndrome Coronariana Aguda (SCA). No entanto, seu valor prognóstico ainda não está plenamente estabelecido em diferentes faixas etárias. OBJETIVO: Avaliar o papel da glicose plasmática de jejum (GPJ) como preditor de evolução, 30 dias após a SCA, e comparar a associação da hiperglicemia com eventos cardiovasculares maiores (ECM): óbito, reinfarto e revascularização, em dois diferentes grupos etários (<65 anos e > 65 anos de idade). MÉTODOS: Coorte contemporânea de pacientes hospitalizados por SCA no Instituto de Cardiologia do Rio Grande do Sul (região sul do Brasil). Nas primeiras 24 horas de internação, os pacientes responderam a um questionário com informações clínicas e foram coletadas amostras de sangue periférico para a medição da GPJ. Os pacientes foram acompanhados durante a internação e por 30 dias para verificar a presença de ECM. A análise estatística foi realizada utilizando o SPSS 15.0 com o teste do qui-quadrado ou Exato de Fisher (variáveis categóricas) e o teste t de Student (variáveis numéricas). Análise multivariável foi utilizada para definir preditores independentes. RESULTADOS: 580 pacientes foram incluídos no estudo. A idade média foi 61,2 (± 12,3) anos, com 38,6% dos pacientes (224) com >65 anos de idade, sendo que 67,7% (393) eram do sexo masculino. A análise multivariada mostrou que, após 30 dias de acompanhamento, apenas a GPJ (OR = 1,01, 95% CI: 1,00-1,01, P = 0,001) esteve associada à ECM nas duas faixas etárias. CONCLUSÃO: A GPJ na internação foi preditor independente de ECM na fase precoce da SCA.

BACKGROUND: The fasting plasma glucose (FPG) test is a predictor of complications after Acute Coronary Syndrome (ACS). However, its prognostic value is not yet fully established in different age groups. OBJECTIVE: To evaluate the role of admission fasting plasma glucose (FPG) as a predictor of 30 days after ACS, and the association of hyperglycemia with major cardiovascular events (MACE): death, reinfarction and coronary artery bypass grafting, in two different age groups (<65 year and >65 year-old patients). METHODS: Contemporary cohort of patients hospitalized for ACS in the Institute of Cardiology of Rio Grande do Sul (Southern Brazil). In the first 24 hours of admission, patients answered a questionnaire with clinical information and had peripheral blood collected for measurement of FPG. Patients were followed up during hospitalization and for 30 days for the presence of MACE. Statistical analyses were performed using the SPSS 15.0 with the chi-square or Fisher Exact test (categorical variables) and the Student t test (numerical variables). Multivariate analysis was performed. RESULTS: 580 patients were included in the study. Mean age was 61.2 (±12.3) years, with 38.6% of the patients (224) >65 years old, and 67.7% (393) were male. Multivariable analysis showed that, after 30 days of follow-up, only FPG (OR= 1.01, 95% CI:1.00-1.01, P= 0.001) was associated with MACE in both age groups. CONCLUSION: Admission FPG was an independent predictor for MACE in the early phase of ACS.

FUNDAMENTO: El examen de la glucosa plasmática de ayuno (GPA) es predictor de complicaciones después de Síndrome Coronario Agudo (SCA). Mientras tanto, su valor pronóstico aun no está plenamente establecido en diferentes franjas etáreas. OBJETIVO: Evaluar el papel de la glucosa plasmática en ayuno (GPA) en la internación como predictor de 30 días después de la SCA, y la asociación de la hiperglicemia con eventos cardiovasculares mayores (ECM): óbito, reinfarto y revascularización, en dos diferentes grupos etáreos (<65 años y > 65 años de edad). MÉTODOS: cohorte contemporánea de pacientes hospitalizados por SCA en el Instituto de Cardiología de Rio Grande do Sul (región sur de Brasil). En las primeras 24 horas de internación, los pacientes respondieron un cuestionario con informaciones clínicas y fueron recolectadas muestras de sangre periférica para la medición de la GPA. Los pacientes fueron controlados durante la internación y por 30 días para verificar la presencia de ECM. Los análisis estadísticos fueron realizados utilizando el SPSS 15.0 con el test del chi-quadrado o Exacto de Fisher (variables categóricas) y el test t de Student (variables numéricas). Fue realizado análisis multivariado. RESULTADOS: 580 pacientes fueron incluidos en el estudio. La edad media fue 61,2 (± 12,3) años, con 38,6% de los pacientes (224) con >65 años de edad, siendo que 67,7% (393) eran del sexo masculino. El análisis multivariado mostró que, después de 30 días de control, apenas la GPA (OR = 1,01, 95% CI: 1,00-1,01, P = 0,001) estuvo asociada a la ECM en las dos franjas etáreas. CONCLUSIÓN: La GPA en la internación fue predictor independiente de ECM en la fase inicial de la SCA.

Effects of the chronic use of dehydroepiandrosterone (DHEA) on testicular weight and spermatogenesis: experimental study in rats.

AIM: The complete biological effects of chronic use of dehydroepiandrosterone (DHEA), reported as a weak androgen, are not completely understood. The aim of the present study is to evaluate the effects of chronic administration of DHEA on the spermatogenesis in rats. METHODS: Male Wistar rats, 4 months old, were selected for the study. The animals were divided into two groups. Group 1 (n = 9) received placebo (saline solution) 0.5 ml/day and Group 2 (n = 15) received DHEA 5 mg/kg/day. Both the groups received the respective treatments 5 days a week during 10 months. At the end of the exposure, the rats were sacrificed and the testes removed, weighed and processed for histologic analysis. Spermatogenesis was evaluated as the mean number of seminiferous tubules with and without spermatids in maturation phase in their lumen, in five random fields on the same slide. RESULTS: The median levels of serum total testosterone and dehydroepiandrosterone sulfate was measured in the two groups. Significant higher concentrations in total testosterone (2.06 +/- 0.4 vs. 0.80 +/- 0.2; p < 0.05) and DHEAS (222.1 +/- 41.5 vs. 2.0 +/- 0.3) were observed in the group treated with DHEA as compared to the control group. The mean weights of the right testes were 1.59 +/- 0.3 in group 1 and 1.58 +/- 0.2 g in group 2 (p > 0.05). These values for the left testes were 1.57 +/- 0.3 and 1.55 +/- 0.3 g, respectively (p > 0.05). The histologic analysis showed a mean of 13.5 +/- 1.5 and 12.8 +/- 1.8 seminiferous tubules per field in the groups 1 and 2, respectively (p > 0.05). The same analysis demonstrated that in the control group 0.06 +/- 0.1 of the tubules presented without spermatids in maturation phase and in the DHEA group this was observed in 0.22 +/- 1.2 of the tubules (p > 0.05). CONCLUSION: Chronic administration of DHEA in the present dose did not show any detectable effect on the quantitative and qualitative analyses of spermatogenesis in rats.

[Bacterial infection in cirrhotic patient]. / Infecção bacteriana no paciente cirrótico.

BACKGROUND: Bacterial infections at admission or during hospitalization are frequent complication of cirrhosis that occurs in about 30% of the cases. Furthermore they are responsible for 25% of deaths in this population. AIM: Evaluate the prevalence of bacterial infections in cirrhotic patients at a general hospital and determine its correlation with alcoholic etiology of liver disease; degree of hepatic dysfunction and upper gastrointestinal bleeding. PATIENTS/METHODS: Five hundred and forty one admissions were retrospectively evaluated in 426 cirrhotic patients at years 1992 to 2000. The mean age was 50.5 years (15-95), being 71.2% male. The alcoholic etiology of cirrhosis was 35.4%. The main outcome considered was discharge or death during admission. RESULTS: One hundred and thirty five episodes of bacterial infections (25%) were diagnosed. The most frequent are urinary tract infection (31.1%), spontaneous bacterial peritonitis (25.9%) and pneumonia (25.2%). The association between urinary tract infection and pneumonia occurred in 3.7% and erysipelas or cellulites in 11.1%. Bacteremia occurred in 2.9%. There was a correlation between bacterial infection and alcoholic etiology of liver disease, hepatic dysfunction and upper gastrointestinal bleeding. The mortality was higher in the infected patients (8.9%) and in those with a poor hepatic function. CONCLUSIONS: Bacterial infections are common complications in cirrhotic patients and are correlated with alcoholic etiology, Child Pugh classification and upper gastrointestinal bleeding. Furthermore, bacterial infections are correlated with poor prognosis.

Effects of chronic administration of dehydroepiandrosterone on serum testosterone levels and prostatic tissue in rats.

PURPOSE: We evaluated the effects of chronic administration of dehydroepiandrosterone (DHEA) on serum total testosterone and DHEA sulfate (DHEAS), prostatic weight and histological features in the rat. MATERIALS AND METHODS: Wistar rats were divided into 2 groups. The first group of 9 rats received saline solution orally once daily during 5 days of the week for 10 months and the second group of 15 received 5 mg/kg daily DHEA in suspension orally in the same pattern. RESULTS: At the end of the 10-month study period total testosterone levels were higher in the DHEA group compared with controls (2.0 +/- 0.4 vs 0.8 +/- 0.2 mg/dl, p <0.0001) and DHEAS levels were also greater in the treated group compared with placebo (222.1 +/- 41.5 vs 2.0 +/- 0.3 mg/dl, p <0.0001). Weight of the prostate, testis and body did not differ between the groups (p >0.05). No differences between the 2 groups were noted in regard to the degree of hyperplasia, atrophy, a papillary component or the stromal-to-gland ratio (p >0.05). CONCLUSIONS: Oral ingestion of DHEA on a chronic basis in the rat increases serum DHEAS and total testosterone without any evident change in prostate weight or histology.

Infecçäo bacteriana no paciente cirrótico / Bacterial infection in cirrhotic patients

RACIONAL: Em torno de 30 por cento dos pacientes com cirrose hepática apresentam infecçäo bacteriana na admissäo hospitalar ou a desenvolvem durante a mesma. As infecções bacterianas säo responsáveis por até 25 por cento das mortes nesta populaçäo de pacientes. OBJETIVO: Avaliar a prevalência de infecçäo bacteriana em uma populaçäo de pacientes cirróticos internados em hospital geral, bem como correlacionar sua presença com a etiologia alcoólica da hepatopatia, com o grau de comprometimento da funçäo hepática e com a presença de hemorragia digestiva alta. PACIENTES E MÉTODOS: Foram avaliadas retrospectivamente 541 internações hospitalares consecutivas em 426 pacientes com cirrose hepática, internados no período de 1992 a 2000. A média de idade destes pacientes foi de 50,5 anos (15-95), sendo 71,2 por cento do sexo masculino. Etiologia alcoólica da hepatopatia esteve presente em 35,4 por cento dos pacientes. Alta ou óbito do paciente no período da internaçäo hospitalar foi considerado como principal desfecho. O nível de significância considerado na análise estatística foi de 5 por cento. RESULTADOS: As infecções bacterianas ocorreram em 25 por cento dos cirróticos (135 episódios). Destas, as mais freqüentes foram: a infecçäo do trato urinário em 31,1 por cento, a peritonite bacteriana espontânea em 25,9 por cento e a broncopneumonia em 25,2 por cento. Ocorreu associaçäo de infecçäo urinária e broncopneumonia em 3,7 por cento e infecçäo de pele e tecido celular subcutâneo em 11,11 por cento. Bacteremia sem foco definido ocorreu nos quatro casos restantes (2,9 por cento). Houve associaçäo da presença de infecçäo com a etiologia alcoólica da hepatopatia, com a classificaçäo de Child-Pugh e com a ocorrência de hemorragia digestiva alta. A mortalidade hospitalar foi maior nos pacientes infectados (8,9 por cento), estando a mesma associada ao grau de disfunçäo hepatocelular. CONCLUSÕES: A ocorrência de infecçäo bacteriana no paciente cirrótico hospitalizado é freqüente e correlaciona-se com a etiologia alcoólica da hepatopatia, com a reserva funcional hepática e com a presença de sangramento digestivo. Além disso, a presença de infecçäo bacteriana correlaciona-se com mau prognóstico.

A erradicação do Helicobacter pylori em pacientes com úlcera duodenal provoca maior incidência de esofagite de refluxo? / Does eradication of helicobacter pylori in patients with duodenal ulcer cause higher incidence of reflux esophagitis?

Os autores propuseram-se avaliar a relação entre a erradicação do helicobacter pylori (HP) em pacientes com úlcera duodenal (UD) e o desenvolvimento de esofagite de refluxo. Para tanto, avaliaram prospectivamente, com duas endoscopias realizadas com intervalo de seis meses cada, 29 pacientes comUD e Hp positivo, tratados com esquema tríplice de antibióticos. No final do seguimento de 12 meses observou-se incidência de esofagite péptica em 25por cento dos casos. Concluiu-se, a despeito do pequeno número de casos e do curto seguimento, que a incidência de esofagite endoscópica é elevada em pacientes com UD após tratamento eo HP.

Ginecomastia como forma de apresentaçäo de tumor de células de Leydig: relato de caso / Leydig cell tumor presenting with gynecomastia: a case report

A avaliaçäo de um paciente masculino, apresentando-se com ginecomastia, é uma situaçäo que requer uma criteriosa avaliaçäo diagnóstica. Os autores apresentam um caso de tumor de células de Leydig cuja principal manifestaçäo clínica foi ginecomastia. Paciente masculino de 34 anos com aumento progressivo do volume mamário, sem qualquer outra sintomatologia associada. Foi submetido à avaliaçäo hormonal, verificando-se prolactina, estradiol e androstenediona aumentados, avaliaçäo ecográfica, diagnosticou lesäo em testículo direito. Submetido à exploraçäo cirúrgica do testículo, diagnosticou-se tumor de células de Leydig. Os autores enfatizam a importância da avaliaçäo diagnóstica em pacientes com ginecomastia