Heme induces significant neutrophil adhesion in vitro via an NFκB and reactive oxygen species-dependent pathway.

Intravascular hemolysis, a major manifestation of sickle cell disease (SCD) and other diseases, incurs the release of hemoglobin and heme from red blood cells, in turn triggering inflammatory processes. This study investigated the in vitro effects of heme, a major inflammatory DAMP, on the adhesive properties of isolated human neutrophils. Heme (20 and 50 µM) significantly increased the adhesion of neutrophils to fibronectin and to recombinant ICAM-1, under static conditions, even more efficiently than the potent pro-inflammatory cytokine, tumor necrosis factor-α (TNF); a microfluidic assay confirmed that heme stimulated neutrophil adhesion under conditions of shear stress. Heme-induced neutrophil adhesion was associated with the increased activities, but not expressions, of the Mac-1 and LFA-1 integrin subunits, CD11b and CD11a, on the cell surface. Notably, heme (50 µM) significantly induced NFκB translocation in neutrophils, and inhibition of NFκB activity with the BAY11-7082 molecule abolished heme-induced cell adhesion to fibronectin and significantly decreased CD11a activity. Flow cytometric analysis demonstrated major reactive oxygen species (ROS) generation in neutrophils following heme stimulation that could be inhibited by the antioxidant, α-tocopherol, and by BAY11-7082. Furthermore, co-incubation with α-tocopherol abrogated both heme-stimulated neutrophil adhesion and CD11a/CD11b activation. Thus, our data indicate that heme, at clinically relevant concentrations, is a potent activator of neutrophil adhesion, increasing the ligand affinity of the ß2 integrins via a mechanism that may be partially mediated by an NFkB-dependent pathway and the generation of ROS. Given the fundamental role that the adhesion of neutrophils to the vascular wall plays in SCD vaso-occlusion and other vascular inflammatory processes, our findings provide further evidence that cell-free heme is a major therapeutic target in the hemolytic diseases.

CXCR4hi effector neutrophils in sickle cell anemia: potential role for elevated circulating serotonin (5-HT) in CXCR4hi neutrophil polarization.

Leukocyte recruitment and heterocellular aggregate formation drive the inflammatory vaso-occlusive processes associated with sickle cell anemia (SCA). We characterized neutrophils in a population of patients with SCA and investigated whether platelet-derived molecules can induce phenotypic alterations in this cell type. Imaging flow cytometry analysis demonstrated that the frequency of circulating CXCR4hi neutrophils was significantly higher in steady-state SCA individuals than in healthy control individuals and that these cells presented increased CD11b activation and toll-like receptor-4 expression. SCA neutrophils display increased neutrophil-platelet aggregation, and CXCR4hi neutrophils demonstrated augmented neutrophil-platelet aggregate frequency with a higher mean number of platelets adhered per neutrophil. Importantly, incubation of neutrophils with platelets significantly elevated their CXCR4 expression, while SCA plasma was found to induce CXCR4hi neutrophil polarization significantly more than control plasma. SCA individuals had significantly increased plasma levels of serotonin (5-HT), and serotonin molecule and SCA plasma induced neutrophil CXCR4 expression in a serotonin-receptor-dependent manner. Thus, the augmented CXCR4hi neutrophil population may contribute to mechanisms that promote vaso-occlusion in SCA; furthermore, circulating serotonin, derived from platelet activation, may play a role in the polarization of neutrophils, suggesting that serotonin-receptor antagonists or serotonin reuptake inhibitors could represent therapeutic approaches to reduce neutrophil activation in SCA.

A preliminary study of simultaneous veterinary drug and pesticide residues in eggs produced in organic and cage-free alternative systems using LC-MS/MS.

In this study, a preliminary food quality and safety assessment was performed on organic and cage-free egg samples marketed in the state of Rio de Janeiro, Brazil, that were analyzed concerning veterinary drug and pesticide residues using high performance and ultra performance liquid chromatography coupled to tandem mass spectrometry. The polyether ionophore salinomycin was detected in two organic egg samples (25% of the organic samples), one with an estimated concentration even higher than the maximum permissible amount of 3 µg kg-1 established for conventional eggs by the European Commission. The other sample presented a concentration higher than the limit of detection of 0.3 µg kg-1, but lower than the lowest calibration level of 1.5 µg kg-1. Regarding pesticide residues, spiroxamine, pirimiphos, mephosfolan and pyraclostrobin were identified at residual levels below the lowest calibration level of 4.5 µg kg-1, except for one organic egg sample, presenting 8.3 µg kg-1 of spiroxamine. Spiroxamine was identified in 62% of the assessed samples. These findings indicate that non-conformities were found even with a limited number of samples, impacting the confidence in the quality of organic and cage-free alternative systems in egg production. The hazard index (HI) approach demonstrated that chemical food safety might be at risk, since a mixture of the detected analytes may pose a risk for children up to 27 kg, through egg consumption.

S100A8 acts as an autocrine priming signal for heme-induced human Mϕ pro-inflammatory responses in hemolytic inflammation.

Intravascular hemolysis, in addition to reducing red cell counts, incurs extensive vascular inflammation and oxidative stress. One product of hemolysis, heme, is a potent danger associated molecular pattern (DAMP), activating leukocytes and inducing cytokine expression and processing, among other pro-inflammatory effects. We explored pathways by which heme-induced inflammation may be amplified under sterile conditions. Incubation of human Mϕs, differentiated from CD14+ cells, with heme induced time- and concentration-dependent gene and protein expression of S100A8, a myeloid cell-derived alarmin. Human Mϕ stimulation with recombinant S100A8, in turn, induced robust pro-IL-1ß expression that was dependent upon NF-κB activation, gene transcription, and partially dependent upon TLR4-mediated signaling. Moreover, heme itself stimulated significant Mϕ pro-IL-1ß gene and protein expression via an S100A8-mediated mechanism and greatly amplified S100A8-driven NLRP3 inflammasome-mediated IL-1ß secretion. In vivo, induction of acute intravascular hemolysis in mice induced a rapid elevation of plasma S100A8 that could be abolished by hemopexin, a heme scavenger. Finally, plasma S100A8 levels were found to be significantly elevated in patients with the inherited hemolytic anemia, sickle cell anemia, when compared with levels in healthy individuals. In conclusion, we demonstrate that hemolytic processes are associated with S100A8 generation and that some of the inflammatory effects of heme may be amplified by autocrine S100A8 production. Findings suggest a mechanism by which hemolytic inflammation could be propagated via leukocyte priming by endogenous proteins, even in sterile inflammatory environments such as those that occur in the hemolytic diseases. S100A8 may represent a therapeutic target for reducing inflammation in hemolytic disorders.

Avaliação dos níveis pressóricos e antropométricos de escolares no interior do nordeste brasileiro / Evaluation of pressoric and anthropometric levels of school children in the brazilian northeastern countryside

Objetivo: Avaliar a influência do excesso de peso nos valores de pressão arterial (PA) de escolares 4 a 17 anos em uma cidade no interior de Sergipe. Metodologia: Trata-se de um estudo transversal, em que foram avaliados 119 estudantes de 5 escolas, por meio de avaliação antropométrica e obtenção dos valores da PA. Os estudantes foram classificados quanto seu estado nutricional e a presença de níveis pressóricos alte-rados de acordo com os percentis propostos pela Organização Mundial da Saúde e da Sociedade Brasileira de Cardiologia, respectivamente. Em seguida, os dados foram analisados estatisticamente com o programa GraphPad Prism V7.0., utilizando-se o teste de Mann Whitney para comparação e o coeficiente de Spearman para correlação entre duas variáveis, sendo adotado como nível de significância, 5%. Resultados:Dos 119 estudantes avaliados, 8,41% foram considerados com baixo peso, 38,32% eutróficos e 53,27% com excesso de peso. Os estudantes com excesso de peso apresentaram maiores medidas de circunferência abdominal. Observou-se uma correlação forte e positiva entre os valores de IMC-z e a razão CA/A, em que os estudantes com maiores valores de IMC-z possuíam também valores maiores da relação CA/A. Além disso, foi constatado maior número de estudantes com níveis considerados PA alterados, dentre aqueles que pos-suíam maiores medidas tanto de IMC-z e quanto da relação CA/A. Conclusão: Crianças e adolescentes com PA alterada apresentaram maior média de IMC e maior relação CA/A em comparação com as que possuíam PA normal, o que evidencia a necessidade de intervenção nessa população para prevenção e promoção da saúde.(AU)

Objective: To evaluate the influence of overweight on blood pressure (BP) values of schoolers aged 4 to 17 years in a city in the Sergipe countryside. Methodology: This is a cross-sectional study, in which 119 students from 5 schools were evaluated through anthropometric evaluation and BP values. The students were classified as their nutritional status and the presence of BP levels altered according to the percentiles proposed by the World Health Organization and the Brazilian Society of Cardi-ology, respectively. Data were then analyzed statistically in the GraphPad Prism V7.0 program, using the Mann Whitney test for comparison and the Spearman coefficient for correlation between two variables, being adopted as a significance level of 5%. Results: Of the 119 students evaluated, 8.41% were con-sidered underweight, 38.32% were eutrophic and 53.27% were overweight. Overweight students presented greater measures of Abdominal Circumference. A strong and positive correlation was also observed between the values of BMI-z and the CA/A ratio, where students with higher BMI-z values also had higher values of the CA/A ratio. In addition, a greater number of stu-dents with altered BP levels were observed among those who had greater measures of both BMI-z and CA/A ratio. Conclusion:Children and adolescents with altered BP had a higher mean BMI and higher CA/A ratio compared to those with normal BP, which reveals the need for intervention in this population for prevention and health promotion. (AU)

Antropometria e estilo de vida de crianças e adolescentes no interior do Nordeste do Brasil / Anthropometry and lifestyle of children and adolescent in inland of northeastern Brazil

INTRODUCTION: Brazil is going through a nutritional transition, which is observed decrease in malnutrition and increased excess weight. OBJETIVE: To evaluate the nutritional status and lifestyle of school children and adolescents from 4 to 17 years old resident in the interior of the Brazilian Northeast. METHODS: This is a longitudinal study performed in two stages. The first stage took place during the School Health Program and anthropometric data were collected from 975 schoolchildren. In the second stage, it was used a questionnaire to assess lifestyle and diet. Participants were classified into "not overweight" and "overweight". The significant level for the statistical tests was set at 5%. RESULTS: In the first stage, less than 2% of students had low height for age. The prevalence of overweight and malnutrition was 22.15% and 5.23%, respectively. Of the 134 participants of the second stage, 47.76% were not overweight and 52.24% overweight. Regarding the lifestyle, the not overweight group had a higher percentage of insufficiently active members (p = 0.017) and a lower intake of vegetables and salads (p=0.015). CONCLUSION: The results revealed low short stature in the population studied and overweight was more prevalent than malnutrition. Children and adolescents had sedentary habits that associated with inappropriate dietary practices favor the occurrence of overweight.

INTRODUÇÃO: O Brasil passa por uma transição nutricional, no qual observa-se diminuição da desnutrição e aumento do excesso de peso. OBJETIVO: Avaliar os dados antropométricos e o estilo de vida de escolares entre 4 a 17 anos do interior do Nordeste brasileiro. MÉTODO: Estudo longitudinal realizado em duas etapas. A primeira ocorreu durante ação do Programa Saúde na Escola e foram coletados os dados antropométricos de 975 escolares. Na segunda etapa foi aplicado questionário para avaliar estilo de vida e alimentação. Os participantes foram estratificados em "sem excesso de peso" e "com excesso de peso" para fins de análise. O nível de significância usado nos testes estatísticos foi de 5%. RESULTADOS: Na primeira etapa, menos de 2,0% dos alunos apresentaram baixa estatura para a idade. A prevalência de excesso de peso e desnutrição foi de 22,15% e 5,23%, respectivamente. Dos 134 participantes da segunda etapa, 47,76% estavam sem excesso de peso e 52,24% com excesso de peso. Com relação ao estilo de vida, o grupo sem excesso de peso apresentou maior porcentagem de integrantes insuficientemente ativos (p = 0,017) e um menor consumo de verduras, legumes e saladas (p = 0,015) CONCLUSÃO: Os resultados demonstraram baixo déficit de estatura na população estudada e o excesso de peso foi mais prevalente que a desnutrição. As crianças e adolescentes apresentaram hábitos sedentários que associados às práticas alimentares inadequadas favorecem a ocorrência do excesso de peso.

Red cell DAMPs and inflammation.

Intravascular hemolysis, or the destruction of red blood cells in the circulation, can occur in numerous diseases, including the acquired hemolytic anemias, sickle cell disease and ß-thalassemia, as well as during some transfusion reactions, preeclampsia and infections, such as those caused by malaria or Clostridium perfringens. Hemolysis results in the release of large quantities of red cell damage-associated molecular patterns (DAMPs) into the circulation, which, if not neutralized by innate protective mechanisms, have the potential to activate multiple inflammatory pathways. One of the major red cell DAMPs, heme, is able to activate converging inflammatory pathways, such as toll-like receptor signaling, neutrophil extracellular trap formation and inflammasome formation, suggesting that this DAMP both activates and amplifies inflammation. Other potent DAMPs that may be released by the erythrocytes upon their rupture include heat shock proteins (Hsp), such as Hsp70, interleukin-33 and Adenosine 5' triphosphate. As such, hemolysis represents a major inflammatory mechanism that potentially contributes to the clinical manifestations that have been associated with the hemolytic diseases, such as pulmonary hypertension and leg ulcers, and likely plays a role in specific complications of sickle cell disease such as endothelial activation, vaso-occlusive processes and tissue injury.

Long-term results of a clinical trial comparing isolated vaginal stimulation with combined treatment for women with stress incontinence.

OBJECTIVE: To determine the efficacy of stress urinary incontinence treatments adding pelvic floor muscle training to vaginal electrical stimulation. METHODS: Forty-eight women with stress urinary incontinence were randomized into 2 groups: 24 underwent isolated vaginal electrical stimulation, and 24 vaginal electrical stimulation plus pelvic floor muscle training. History, physical examination, voiding diary, perineum strength test, and urodynamic study were assessed. Comparisons were made for adherence to treatment, muscle strength improvement, urinary symptoms, and degree of satisfaction immediately, 12 and 96 months after treatment. RESULTS: Patients' degree of satisfaction on vaginal electrical stimulation, and on vaginal electrical stimulation plus pelvic floor muscle training immediately, 12 and 96 months post treatment, were, respectively: 88.2% versus 88.9% 64.7% versus 61.1% and 42.9% versus 28.6% (p>0.05). CONCLUSION: Vaginal electrical stimulation associated to pelvic floor muscle training did not show better results than vaginal electrical stimulation alone.

Long-term results of a clinical trial comparing isolated vaginal stimulation with combined treatment for women with stress incontinence / Resultados a longo prazo de um estudo clínico comparando estimulação vaginal isolada com tratamento combinado para mulheres com incontinência urinária de esforço

Objective To determine the efficacy of stress urinary incontinence treatments adding pelvic floor muscle training to vaginal electrical stimulation. Methods Forty-eight women with stress urinary incontinence were randomized into 2 groups: 24 underwent isolated vaginal electrical stimulation, and 24 vaginal electrical stimulation plus pelvic floor muscle training. History, physical examination, voiding diary, perineum strength test, and urodynamic study were assessed. Comparisons were made for adherence to treatment, muscle strength improvement, urinary symptoms, and degree of satisfaction immediately, 12 and 96 months after treatment. Results Patients’ degree of satisfaction on vaginal electrical stimulation, and on vaginal electrical stimulation plus pelvic floor muscle training immediately, 12 and 96 months post treatment, were, respectively: 88.2% versus 88.9% 64.7% versus 61.1% and 42.9% versus 28.6% (p>0.05). Conclusion Vaginal electrical stimulation associated to pelvic floor muscle training did not show better results than vaginal electrical stimulation alone. .

Objetivo Determinar a eficácia da eletroestimulação vaginal combinada com treinamento muscular do assoalho pélvico para o tratamento da incontinência urinária de esforço. Métodos Um total de 48 mulheres com incontinência urinária de esforço foi randomizado em 2 grupos, sendo 24 submetidas a eletroestimulação vaginal isolada e 24 a eletroestimulação vaginal e treinamento muscular do assoalho pélvico. Foram avaliados anamnese, exame físico, diário miccional, força perineal e urodinâmica. Compararam-se a adesão ao tratamento, a melhora da força muscular perineal e dos sintomas urinários, e o grau de satisfação imediatamente, 12 e 96 meses após o tratamento. Resultados O grau de satisfação das pacientes no grupo da eletroestimulação isolada e do segundo grupo, imediatamente, com 12 e com 96 meses foi, respectivamente, 88,2% versus 88,9% 64,7% versus 61,1% e 42,9% versus 28,6% (p>0,05). Conclusão A eletroestimulação vaginal associada ao treinamento muscular do assoalho pélvico não foi mais eficaz do que a eletroestimulação isolada. .

Estudo do papel da Insularina (GST-INS) na inibição da adesão de células endoteliais às plaquetas e na indução do descolamento de células HUVECs

Intensos estudos têm sido realizados utilizando a rede de integrinas como alvo do controle da adesão e migração das células tumorais. Este mecanismo envolve interações adesivas de células tumorais com células endoteliais e plaquetas. A literatura vem elucidando a importância das disintegrinas, proteínas isoladas de venenos de serpentes Viperidae, como importantes ferramentas para o desenvolvimento de antagonistas de patologias dependentes de adesão celular como a trombose e angiogênese. As disintegrinas inibem a agregação plaquetária e a adesão celular, apresentando heterogeneidade estrutural e funcional. As RGD-disintegrinas têm afinidade pelas integrinas αIIβ3, α5β1 e αvβ3 expressas em plaquetas e outras células, incluindo as células endoteliais vasculares e algumas células tumorais. Dados recentemente publicados pelo nosso grupo demonstraram que a insularina, GST-INS, uma disintegrina ARGDNP recombinante do veneno de Bothrops insularis, foi capaz de inibir a agregação plaquetária via ADP e a inibição da adesão de células endoteliais ao fibrinogênio de forma significante. Alguns estudos mostram que as disintegrinas afetam principalmente os vasos recém-formados, mas não os grandes vasos pré-existentes. No entanto, apenas alguns relatos têm investigado os efeitos das disintegrinas na desadesão celular. Tais dados nos incentivaram, através do presente trabalho, elucidar o potencial da GST-INS na inibição da aderência de HUVECs (Human Umbilical Vein Endothelial Cell) que superexpressa αIIβ3e αvβ3 às plaquetas e verificar a capacidade desta molécula na indução do descolamento de células HUVECs, contribuindo, dessa forma, para a elucidação e inserção dessa molécula no contexto do desenvolvimento de agentes anti-angiogênicos, uma vez que a angiogênese tumoral e a metástase são fenômenos muitas vezes dependentes da interação das integrinas.

Respostas celulares e bioquímicas induzidas por bioterápicos preparados a partir de influenza A (H3N2) íntegro e influenza A (H3N2) inativado nas potências 12x e 30x na linhagem MDCK / Cellular and biochemical responses induced by Biotherapics prepared from intact influenza A (H3N2) and inactivated influenza A (H3N2) virus at 12x and 30x in the MDCK cells

Biotherapics are homeopathic remedies prepared from organic products that are chemically undefined and can be used for treatment of diseases like influenza. There are several classes of biotherapics and, among these, there are some called "living biotherapics" or "Roberto Costa?s Biotherapics". This study aimed to compare the cellular and biochemical effects of biotherapics prepared from intact influenza virus diluted in water and the one obtained from the same viral sample inactivated by ethanol 70% (v / v), both in the potencies of 12x and 30x. Transmission electron microscopy (TEM) analyses were performed on both preparations to assess the integrity of viral particles, which showed that ethanol 70% (v/v) induced a complete denaturation of viral particles. In contrast, the integrity of virus particles was preserved when water was used as the biotherapic solvent. Cellular and biochemical alterations induced by the preparations on MDCK cells were analyzed and compared with those induced by respective controls (water 30x-treated and untreated cells). Cellular viability analyzed by MTT method showed statistically significant differences (p <0.05) in MDCK cells treated with intact biotherapic for 5 (3 stimuli) and 30 (18 stimuli) days in comparison with untreated control. TEM analysis did not show significant cellular changes when the different experimental groups were compared. The enzymatic activity of phosphofructokinase 1 (PFK), an important enzyme in the glycolytic pathway, presented a statistically significant increase (p <0.05) after 30 days of treatment when compared to control groups. The results obtained suggest that inactivation of viral sample with ethanol 70% induces lysis and disruption of viral particles. In addition, preliminary results indicated that treatment with intact biotherapic seems to induce higher variations on MDCK cells responses when compared to inactivated-biotherapic-treated cells. Further analyses are ongoing, including scanning electron microscopy and quantification of the number of mitosis, in order to elucidate the mechanisms involved with biochemical and cellular responses induced by theses biotherapics.(AU)

Long-term outcome of laparoscopic pyeloplasty: multicentric comparative study of techniques and accesses.

PURPOSE: The aim of the present study was to analyze long-term follow up (18-108 months) of different techniques and routes for laparoscopic repair of uretero-pelvic junction obstruction comparing efficacy and results. MATERIALS AND METHODS: A retrospective analyses of 133 laparoscopic pyeloplasties in 132 patients (mean age 35 years) between August 1995 and November 2008 was performed. Transperitoneal route was performed in 114 patients, and retroperitoneal route was performed in 19 patients. Different repair techniques (dismembered and non-dismembered) were applied at the surgeon's discretion. RESULTS: Average operative time was 127 minutes (range 45-370). Average blood loss was 127 mL, and mean hospital stay was 24 hours. Complications occurred in 9.6% of surgeries, and conversion rate was 1.7%. Urinary leak occurred after eight (6.1%) surgeries, all managed conservatively. Overall success rate of laparoscopic repair was 96%, higher for dismembered versus non-dismembered procedures (97% versus 89%, P = .04). CONCLUSION: Laparoscopic pyeloplasty is a reproducible, highly effective, and minimally invasive treatment for uretero-pelvic junction obstruction. Surgical technique affects operative time and long-term success rates. Dismembered techniques seem to remain more effective after a long-term follow up. Surgical route does not seem to affect success rates.

Cardiovascular and metabolic syndrome risk among men with and without erectile dysfunction: case-control study.

CONTEXT AND OBJECTIVE: Erectile dysfunction has been associated with cardiovascular diseases. The aim here was to evaluate cardiovascular risk through the Framingham Risk Score (FRS) criteria, C-reactive protein (CRP) assays and presence of metabolic syndrome (MS) in men with and without erectile dysfunction diagnosed within a healthcare program. DESIGN AND SETTING: A retrospective case-control study was conducted. The patients were selected from a healthcare program at the Hospital Israelita Albert Einstein, between January and December 2007. METHODS: 222 men were retrospectively selected, and they were divided into two groups: men with erectile dysfunction (n = 111) and men without erectile dysfunction (n = 111). The patients were stratified according to the International Index of Erectile Function-Erectile Function domain (IIEF-EF domain). CRP and FRS were analyzed and the two groups were compared. RESULTS: The CRP levels were significantly higher among men with erectile dysfunction (P = 0.04). Patients with erectile dysfunction also had high FRS (P = 0.0015). CRP and FRS did not correlate with the severity of erectile dysfunction. The presence of metabolic syndrome was greater among men with erectile dysfunction (P < 0.05). The severity of erectile dysfunction was directly associated with metabolic syndrome. CONCLUSION: Men with erectile dysfunction presented higher cardiovascular risk according to the FRS criteria and CRP measurements. Severe erectile dysfunction seemed to have a correlation with metabolic syndrome.

Cardiovascular and metabolic syndrome risk among men with and without erectile dysfunction: case-control study / Risco cardiovascular e da síndrome metabólica entre homens com e sem disfunção erétil: estudo caso controle

CONTEXT AND OBJECTIVE: Erectile dysfunction has been associated with cardiovascular diseases. The aim here was to evaluate cardiovascular risk through the Framingham Risk Score (FRS) criteria, C-reactive protein (CRP) assays and presence of metabolic syndrome (MS) in men with and without erectile dysfunction diagnosed within a healthcare program. DESIGN AND SETTING: A retrospective case-control study was conducted. The patients were selected from a healthcare program at the Hospital Israelita Albert Einstein, between January and December 2007. METHODS: 222 men were retrospectively selected, and they were divided into two groups: men with erectile dysfunction (n = 111) and men without erectile dysfunction (n = 111). The patients were stratified according to the International Index of Erectile Function-Erectile Function domain (IIEF-EF domain). CRP and FRS were analyzed and the two groups were compared. RESULTS: The CRP levels were significantly higher among men with erectile dysfunction (P = 0.04). Patients with erectile dysfunction also had high FRS (P = 0.0015). CRP and FRS did not correlate with the severity of erectile dysfunction. The presence of metabolic syndrome was greater among men with erectile dysfunction (P < 0.05). The severity of erectile dysfunction was directly associated with metabolic syndrome. CONCLUSION: Men with erectile dysfunction presented higher cardiovascular risk according to the FRS criteria and CRP measurements. Severe erectile dysfunction seemed to have a correlation with metabolic syndrome.

CONTEXTO E OBJETIVO: Disfunção erétil está associada a doenças cardiovasculares. O objetivo foi avaliar o risco cardiovascular através dos critérios de Framingham (FRS), da dosagem de proteína C-reativa e da presença de síndrome metabólica em homens com e sem disfunção erétil diagnosticados em um programa de saúde. TIPO DE ESTUDO E LOCAL: Estudo retrospectivo tipo caso-controle foi realizado. Os pacientes foram selecionados de um programa de saúde do Hospital Israelita Albert Einstein, no período de janeiro a dezembro de 2007. MÉTODOS: 222 homens foram retrospectivamente selecionados e divididos em dois grupos: homens com disfunção erétil (n = 111) e homens sem disfunção erétil (n = 111). Os pacientes foram estratificados de acordo com o Índice Internacional de Disfunção Erétil (International Index of Erectile Function, Erectile Function domain, IIEF-EF domain). A proteína C-reativa e o escore de Framingham foram analisados e os dois grupos foram comparados. RESULTADOS: O nível da proteína C foi significativamente maior entre homens com disfunção erétil (P = 0,04). Pacientes com disfunção erétil também tinham um escore de risco de Framingham alto (P = 0,0015). A proteína C e o escore de Framingham não se correlacionaram com o grau de gravidade da disfunção erétil. A presença de síndrome metabólica foi maior nos pacientes com disfunção erétil (P < 0,05). A gravidade da disfunção erétil esteve diretamente associada com a síndrome metabólica. CONCLUSÃO: Homens com disfunção erétil apresentaram maior risco cardiovascular de acordo com os critérios de Framingham e pela mensuração da proteína C-reativa. A disfunção erétil grave em homens parece ter correlação com a síndrome metabólica.

Mucoid cyst of the penis: Case report and literature review.

Penile cysts are uncommon lesions. In general, they are asymptomatic and do not interfere with sexual function. Most of them are present since birth, but usually they are only detectable in adolescence or adulthood. We report a rare case of a young adult man with a 5 × 5-cm nodule on the prepuce (ventral face), which appeared 2 years ago and interfered with his sexual function. The nodule was excised by circumcision and a histopathologic study was performed. Histopathologic examination revealed a mucoid cyst of penis with epidermoid metaplasia. No recurrence was observed at a 6 months follow-up and the patient's sexual function returned to normal.

Isolated anterior urethral trauma in man after coitus:a case report / Trauma isolado de uretra anterior masculina após coito: relato de caso

Penile fracture with or without urethral injury after coitus presents with severe pain and immediate penile detumescence accompanied by a cracking sound. Hematuria or voiding difficulty are common findings and suggest associated urethral injury. The objective of this report is to describe an unusual complication of coital trauma diagnosed based on clinical findings. The isolated urethral injury is rare but is one of the causes of male coital trauma and may be suspected when patients present urethral bleeding.

Fratura de pênis com ou sem lesão de uretra é a principal lesão ocorrida durante o ato sexual e se apresenta com dor intensa, rápido intumescimento e estalido. Hematúria ou dificuldade miccional são sintomas incomuns, que sugerem lesão de uretra associada. O objetivo do trabalho foi relatar essa rara complicação de lesão isolada de uretra durante o intercurso sexual cujo diagnóstico se acha baseado em achados clínicos. A lesão isolada de uretra, embora rara, pode ocorrer durante o intercurso sexual e deve ser suspeitada na presença de uretrorragia.

Female urethral diverticulum associated witha large urinary calculus / Divertículo de uretra feminina associado a grande cálculo urinário

The diverticula of female urethra are very uncommon, but more frequently found between the third and fifth decade of life. Diverticula area mostly relate to repeated urinary infections of the periurethral glands or urethras trauma. The diverticula may cause infection, calculus formation and rarely endometriosis or cancer. A case of a 65-year old Caucasian female with vaginal mass over six months is herein reported. There was no urinary loss, urethral secretion or urinary symptoms. A cystourethrography showed diverticula with calculus inside. The patient was submitted to surgery and dismissed from the hospital on the first postoperative day. The pathologic examination revealed no malignancy. In six months of follow-up, the patient was continent with no complaints.

Os divertículos de uretra feminina são incomuns, porém mais frequentes entre a terceira e a quinta década de vida. A maioria dos divertículos de uretra está relacionada a infecções recorrentes das glândulas periuretrais ou traumatismo uretral. Os divertículos podem ser sítio de infecções, formação de cálculos e, mais raramente, endometriose ou neoplasia. Relata-se o caso de paciente de 65 anos, branca, com queixa de nódulo em parede vaginal notado há seis meses. Negava incontinência urinária, derrame uretral e sintomas urinários de armazenamento ou de esvaziamento. A uretrocistografia miccional revelou divertículo uretral associado a cálculo. Submetida à cirurgia, teve alta hospitalar no primeiro dia pós-operatório. O resultado do exame anatomopatológico não evidenciou malignidade. Após seis meses de seguimento, a paciente encontra-se sem queixas urinárias ou vaginais e com continência urinária preservada.

Somatostatinoma de duodeno: relato de caso e revisão da literatura / Duodenal somatostatinoma: case report and literature review

Introdução: Somatostatinomas são tumores carcinóides produtores de somatostatina, localizados principalmente na cabeça do pâncreas e duodeno. A importância desse relato deve-se à raridade deste subtipo histológico. Relato de Caso: Mulher, 68 anos, portadora de diabetes mellitus há dois anos, com queixa de dor abdominal há cinco meses. Ao exame físico notava-se massa em epigástrio e hipocôndrio direito, fixa e dolorosa à palpação. A ultra-sonografia e a tomografia computadorizada de abdome evidenciaram, respectivamente, colelitíase e tumor sólido em topografia de cabeça de pâncreas, medindo cerca de 12 x 8 cm. A paciente foi submetida a procedimento cirúrgico, no qual foi encontrado um grande tumor envolvendo o duodeno e o pâncreas, optando-se pela gastroduodenopancreatectomia cefálica e colecistectomia. Os exames anátomo-patológico e imuno-histoquímico da peça operatória revelararam tratar-se de um somatostatinoma de duodeno (estadiamento: T4N0Mx). A paciente apresentou boa evolução no pós-operatório, e com 18 meses da cirurgia encontra-se sem sinais de recidiva tumoral. Discussão: Os somatostatinomas são tumores raros, geralmente malignos, mais freqüentemente encontrados no pâncreas, sendo que apenas 2,5% deles são funcionantes. O diagnóstico é realizado por exame anátomo-patológico e imuno-histoquímico e o tratamento de escolha é a ressecção cirúrgica. Quando a cirurgia curativa não pode ser realizada, alguns pacientes podem se beneficiar de procedimentos paliativos e/ou quimioterapia. O seguimento deve ser realizado a cada seis meses com tomografia abdominal e a dosagem sérica de somatostatina pode ser um método complementar. A sobrevivência em cinco anos após a retirada completa do tumor e na ausência de linfonodos comprometidos ou metástases chega a 100%.

Introduction: Somatostatinomas are rare somatostatin-producing carcinoid tumors, mainly found in the duodenum and pancreatic head. The importance of this case report lies in the rarity of such histological subtype. Case Report: Sixty-eight years old female patient with a two-year diabetes history and five-month abdominal pain complaint. Physical examination revealed a tumor in the epigastrium and right hypochondrium, immovable and painful upon palpation. Ultrasound and abdominal computerized tomography showed, respectively, calculous chronic cholecystitis and solid tumour, measuring approximately 12 x 8 cm, located in pancreatic head topography. The patient was submitted to surgery in which a large tumor was found evolving duodenum and pancreas. Cephalic gastroduodenopancreatectomy and cholecistectomy were performed. The anatomopathological and immunohistochemical study of the surgical piece revealed a duodenal somatostatinoma (stage: T4N0Mx). The patient afforded good postoperative evaluation and after 18 months from surgery, presented no signs of tumor recurrence. Discussion: Somatostatinomas are rare, usually malignant tumors, more frequently found in the pancreas, and only 2.5% are functional. Diagnosis is established by anatomopathological and immunohistochemical exams and the chosen treatment is surgical resection. When curative surgery cannot be performed, some patients may benefit from palliative surgery and/or chemotherapy. Follow-up must take place every six months with abdominal tomography and serum somatostatin dosage could be a complementary method. The five-year survival rate is 100% upon complete tumor resection with the absence of affected lymph nodes or metastasis.