Effect of clarified Brazilian native fruit juices on postprandial glycemia in healthy subjects.

Brazilian native fruits have been shown as excellent sources of polyphenols which are associated with multiple biological activities including inhibition of carbohydrate-hydrolyzing enzymes, α-amylase and α-glucosidase. Postmeal blood glucose elevations and high glycemic index diets can play a major role in the development of type 2 diabetes, therefore alternative approaches to reduce postprandial hyperglycemia are of growing interest in order to reduce diabetes risk. Here we investigated the effect of six Brazilian native clarified fruit juices from Amazon, Savannah and Atlantic Forest biomes on postprandial glycemia after consumption of a carbohydrate meal. For this, 23 healthy subjects were selected to consume seven meal tests, with a 1-week interval among them, consisting in 50g white bread plus 300mL of water (control) or cambuci, cagaita, maracujá-alho, cupuaçu, camu-camu and jaboticaba clarified fruit juices. The results showed that serum glucose concentrations were significantly lower after consumption of cambuci, cagaita, camu-camu and jaboticaba juices, whereas maracujá-alho and cupuaçu juices did not decrease the amount of glucose absorbed, compared to control (p<0.05). In addition, cagaita, cambuci, cupuaçu and jaboticaba juices increased the oxygen radical absorbance capacity in plasma, whereas all juices augmented the ferric reducing ability of plasma, except for cambuci (p<0.05). These results indicate that juices from Brazilian native fruits may be considered as adjuvant treatment for reduction of postprandial glycemia in healthy subjects.

Experience with 53 portal-duodenal drained solitary pancreas transplants.

Systemic-enteric drainage is currently the most common technique for pancreas transplantation (PT). A novel alternative technique, portal-duodenal drainage (PDD), has potential physiological benefits and provides improved monitoring of the pancreatic graft. The current study describes 53 solitary PT procedures (43 pancreas after kidney and 10 pancreas transplant alone) using the PDD technique over the last three yr. This method resulted in one-yr patient survival at 96% and 83% graft survival. There were five cases (9.4%) of thrombosis, in which transplantectomy and two-layer closure of the native duodenum were performed. No fistulas were observed. Here, we demonstrate that the PDD technique in PT was as safe and effective as current techniques in clinical use.

Assessment of the role of transcript for GATA-4 as a marker of unfavorable outcome in human adrenocortical neoplasms.

BACKGROUND: Malignant neoplasia of the adrenal cortex is usually associated with very poor prognosis. When adrenocortical neoplasms are diagnosed in the early stages, distinction between carcinoma and adenoma can be very difficult to accomplish, since there is yet no reliable marker to predict tumor recurrence or dissemination. GATA transcription factors play an essential role in the developmental control of cell fate, cell proliferation and differentiation, organ morphogenesis, and tissue-specific gene expression. Normal mouse adrenal cortex expresses GATA-6 while its malignant counterpart only expresses GATA-4. The goal of the present study was to assess whether this reciprocal change in the expression of GATA factors might be relevant for predicting the prognosis of human adrenocortical neoplasms. Since human adrenal cortices express luteinizing hormone (LH/hCG) receptor and the gonadotropins are known to up-regulate GATA-4 in gonadal tumor cell lines, we also studied the expression of LH/hCG receptor. METHODS: We conducted a study on 13 non-metastasizing (NM) and 10 metastasizing/recurrent (MR) tumors obtained from a group of twenty-two adult and pediatric patients. The expression of GATA-4, GATA-6, and LH/hCG receptor (LHR) in normal and tumoral human adrenal cortices was analysed using reverse transcriptase-polymerase chain reaction (RT-PCR) complemented by dot blot hybridization. RESULTS: Messenger RNA for GATA-6 was detected in normal adrenal tissue, as well as in the totality of NM and MR tumors. GATA-4, by its turn, was detected in normal adrenal tissue, in 11 out of 13 NM tumors, and in 9 of the 10 MR tumors, with larger amounts of mRNA found among those presenting aggressive clinical behavior. Transcripts for LH receptor were observed both in normal tissue and neoplasms. A more intense LHR transcript accumulation was observed on those tumors with better clinical outcome. CONCLUSION: Our data suggest that the expression of GATA-6 in human adrenal cortex is not affected by tumorigenesis. GATA-4 expression is more abundant in MR tumors, while NM tumors express more intensely LHR. Further studies with larger cohorts are needed to test whether relative expression levels of LHR or GATA-4 might be used as prognosis predictors.

Disseminated histoplasmosis presenting as bilateral adrenal masses

Histoplasma capsulatum e um fungo universal dimorfico encontrado principalmente em solo contaminado com fezes de aves e morcegos. A apresentacao clinica inicial dos casos de histoplasmose disseminada raramente se caracteriza pela presenca de massas supra-renais bilaterais e insuficiencia adrenal por desnutricao tecidual importante. Por ser um agente oportunista existe maior susceptibilidade para os quadros de disseminacao naqueles pacientes com imunodeficiencia ou imunosupressao. Nos relatamos um caso de uma paciente idosa e diabetica com aumento bilateral das supra-renais e apresentacao clinica vaga, sendo feito o diagnostico de histoplasmose disseminada apenas apos a exploracao cirurgica das supra-renais. Possivelmente se passaram 60 anos entre a infeccao primaria e o inicio dos sintomas. O tratamento foi realizado com uso de itraconazol

Alteraçoës eletrocardiográficas nas pancreatites / Electrocardiographic changes in pancreatitis

A pancreatite é uma doença grave com mortalidade superior a 20%. A sua apresentaçäo clínica pode confundir-se com infarto do miocárdio ou angina de peito. Foi propósito deste trabalho o estudo dos eletrocardiogramas (ECG) de pacientes internados no Hospital das Clínicas da FMUSP com diagnóstico de pancreatite. Foram obtidos os ECG de 54 pacientes de um total de 400 doentes atendidos. Cerca de 80% dos traçados estavam alterados e as alteraçöes mais freqüentes foram: taquicardia sinusal e alteraçöes difusas da repolarizaçäo. Foram registrados bloqueios de ramo na vigência de pancreatite que näo existiam antes ou que desapareceram depois da fase aguda. Também foram observados efeito dielétrico (complexos de baixa voltagem) e corrente de lesäo