Central adiposity and decreased heart rate variability in postmenopause: a cross-sectional study.

OBJECTIVE: To investigate the impact of waist circumference (WC) on heart rate variability in 87 apparently healthy, postmenopausal women. METHODS: In this cross-sectional study, time- and frequency-domain heart rate variability indices were determined at rest and during sympathetic stimulation with mental stress. Patients were stratified according to WC ≥ or < 88 cm. The mean (± standard deviation) age was 55 ± 5 years. The median time since menopause was 6 (range 1-22) years. Age and time since menopause were similar. RESULTS: The mean body mass index was 27.12 ± 4.49 kg/m². Metabolic syndrome was diagnosed in 26 (29.5%) participants. Thirty-eight participants (43.6%) had hypertension. Women with WC ≥ 88 cm had higher body mass index, glucose and insulin (both fasting and after a 75-g oral glucose tolerance test), HOMA, triglycerides, and free androgen index (p < 0.05). The metabolic syndrome was more frequent in women with WC ≥ 88 cm (24.13% vs. 5.74%; p < 0.01). At rest, women with WC ≥ 88 cm presented lower vagal modulation, expressed by a reduction in the mean of all normal RR intervals (mean RR) (p < 0.01) and root mean square of successive differences of adjacent RR intervals (rMSSD) (p < 0.05) than women with WC < 88 cm. Mental stress significantly increased sympathetic modulation in both groups, expressed by reduction in high frequency (HF), increase in low frequency (LF) and LF/F ratio, and reduction in mean RR and rMSSD. CONCLUSIONS: Less favorable metabolic profile and lower cardiac vagal modulation with preserved sympathetic responsiveness were found in participants with WC ≥ 88 cm, suggesting that central adiposity may be associated with decreased heart rate variability in apparently healthy, postmenopausal women.

Hip circumference is associated with high density lipoprotein cholesterol response following statin therapy in hypertensive subjects.

AIM: This report investigated the relationship between anthropometric measurements of body fat distribution and lipid response to statins in hypercholesterolemic hypertensive patients. METHODS: We prospectively examined 129 subjects who used either simvastatin 20 mg/day (no.=83) or atorvastatin 10 mg/day (no.=46) for 3 months. Anthropometry included evaluation of body mass index, waist and hip circumferences, and waist-to-hip-ratio. RESULTS: Significant decreases in LDL (p<0.001), total cholesterol (p<0.001), and triglycerides (p=0.04) levels were detected after 3 months of therapy in the whole sample. At baseline, only an inverse correlation between waist circumference and HDLcholesterol levels was detected (r=-0.18; p=0.04). Conversely, a direct relationship between hip circumference and HDLcholesterol response to statins was found in the whole sample (r=0.24; p=0.006), while no other anthropometric measurement displayed significant correlation with lipid changes. The association between HDL-cholesterol response and hip circumference was further confirmed by stepwise regression analysis adjusted for baseline HDL-cholesterol levels, metabolic syndrome, body mass index, and waist circumference. CONCLUSIONS: Hip circumference, a surrogate marker of peripheral adiposity, is associated with HDL-cholesterol changes following statin therapy in hypertensive patients.

Tei index to assess fetal cardiac performance in fetuses at risk for fetal inflammatory response syndrome.

OBJECTIVES: To examine, in patients with premature rupture of the amniotic membranes (PROM) at < 34 weeks of gestation, the relationship between fetal myocardial performance measured by the Tei index and fetal inflammatory response syndrome (FIRS). METHODS: A case-control study was conducted including 15 preterm PROM patients with gestational age between 24 and 33 weeks admitted to Hospital de Clínicas de Porto Alegre, and 15 controls with the same gestational age range. Fetal echocardiography with Doppler was performed at admission for the preterm PROM group, with serial examinations every 7-10 days thereafter until delivery, and at the time of inclusion in the control group. Flow velocity waveforms were obtained for the left ventricle, from which the Tei index was calculated. Placental histopathology and perinatal outcome were compared between the groups. RESULTS: The left ventricular Tei index was significantly greater in fetuses with preterm PROM compared with controls (0.63 +/- 0.13 vs. 0.51 +/- 0.10, P = 0.007). While there was no difference in isovolumetric times, the left ventricular ejection time was significantly shorter in the preterm PROM group (164 +/- 17 ms vs. 184 +/- 16 ms, P = 0.003). In the preterm PROM group, neonatal sepsis was diagnosed in 73.3%, and funisitis and chorionic vasculitis confirmed FIRS in 53.3%, compared with 6.7% for these three diagnoses in controls (P = 0.001). CONCLUSIONS: These data provide further evidence that cardiac dysfunction is present in the setting of preterm PROM. The study of myocardial performance with the Tei index is a novel non-invasive approach to assess cardiac function and monitor the fetus affected with FIRS.

Nematodes of Rhynchophorus palmarum, L. (Coleoptera: Curculionidae), vector of the Red Ring Disease in coconut plantations from the north of the Rio de Janeiro State.

Rhynchophorus palmarum, the palm weevil, has been reported as a pest of palms and sugarcane plants. The Red Ring Disease is an infectious plant disease caused by nematodes. The etiological agent, Bursaphelencus (Rhadinaphelencus) cocophilus (Nematoda: Aphelenchoididae), completes its life cycle within 9 to 10 days inside the palm tree. The main symptom is a permanent wilting of the plant aerial parts. Previous studies stated that B. cocophilus cohabits with other nematodes the gut of R. palmarum. The aim of this study is to identify nematodes collected from palm weevil found in coconut plantations from the north of the Rio de Janeiro State. Light (LM) and scanning electron microscopy (SEM) analyses were carried on samples of infected R. palmarum and fragments and fresh juice of infected plants with B. cocophilus. Observations of R. palmarum fecal material made by LM and SEM showed three species cohabiting these samples, being also present in fresh juice and fragments of infected coconut tree: B. cocophilus, Teratorhabditis palmarum (Nematoda: Rhabditidae) and Diplogasteritus sp (Nematoda: Diplogasteridae). These findings confirm previous studies, which related that R. palmarum own a varied nematode fauna. Nematodes associated to B. cocophilus probably could be co-participates of the etiology of the Red Ring disease.

Severe fetal hydrocephalus with and without neural tube defect: a comparative study.

OBJECTIVE: To describe the main perinatal and 1-year outcomes in babies with a prenatal ultrasonographic diagnosis of severe hydrocephalus according to the presence or absence of a neural tube defect (NTD) in a country where abortion is illegal. METHOD: The study population consisted of cases referred to and delivered at Hospital de Clínicas de Porto Alegre, diagnosed between January 1993 and December 2001. The diagnosis of severe hydrocephalus was based on a lateral ventricular atrium diameter > or =15 mm in at least one hemisphere. RESULTS: Sixty cases were ascertained: 28 with NTD (group 1) and 32 without NTD (group 2). The groups were similar in terms of maternal and child variables at birth and hospitalization days during the 1st year of life. The mortality (including intrauterine deaths and deaths of babies with malformations incompatible with life that characterize a very poor prognosis) until 1 year of age was 36% in group 1 and 59% in group 2 (p = 0.077). The rate of cardiac malformations was higher in the group without NTD (p = 0.015). The length of hospital stay after birth (1st admission) was significantly higher in the group with NTD (p = 0.007). CONCLUSIONS: The morbidity was higher in the group with NTD, possibly due to the higher number of surgical interventions in the central nervous system. However, the mortality was higher in the group without NTD, possibly due to the presence of other associated malformations, especially congenital heart disease. Further studies should focus on neurological function and quality of life of the children and their families at the end of the 1st year and after 2 or 6 years of age.

Subendometrial power Doppler quantification: a new classification proposal.

Fifty-two women with regular menses were enrolled in the study. The patients were not allowed to use non-steroidal anti-inflammatory drugs within 24 h of any examination. All patients were examined during the mid-luteal phase (6-9 days after ovulation, according to previous ultrasound record). Power Doppler energy levels were classified into five categories according to the per cent area of sub-endometrial signal: I (<10%), II (10-25%), III (25-50%), IV (50-75%) and V (>75%). The colour Doppler signal was considered positive when it reached at least the endometrial basal layer. The picture of the endometrium was analysed and the regions of interest were identified and marked for further analysis. Each recorded image was then independently evaluated and classified by three blinded observers. According to the power Doppler classification, age, body mass index (BMI) and endometrial thickness were analysed, and no significant differences were observed among them. The Kappa test (0.70) demonstrated an excellent agreement among examiners (P = 0.0001). This study has validated a very simple and cost-effective classification for sub-endometrial vascularization. This method of quantification may potentially be of use, and its relevance to clinical practice should be explored.

Relation of cervical length at 22-24 weeks of gestation to demographic characteristics and obstetric history

Preterm delivery is the main cause of neonatal death and ultrasonographic cervical assessment has been shown to be more accurate than digital examination in recognizing a short cervix. This is a cross-sectional study, involving 1131 women at 22-24 weeks of pregnancy, designed to determine the distribution of cervical length and to examine which variables of demographic characteristics and obstetric history increase the risk of a short cervix (15 mm or less). The distribution of maternal demographic and obstetric history characteristics among patients with cervical length ú15 mm was analyzed and compared to the findings for the general population. Risk ratios (RR) between subgroups were generated from this comparison. Median cervical length was 37 mm and in 1.5 percent of cases it was 15 mm or less. The proportion of women with a short cervix (<=15 mm) was significantly higher among patients with a low body mass index (RR = 3.5) and in those with previous fetal losses between 16-23 weeks (RR = 33.1) or spontaneous preterm deliveries between 24-32 weeks (RR = 14.1). We suggest that transvaginal sonographic measurement of cervical length be performed as part of a routine midtrimester ultrasound evaluation. There are specific variables of demographic characteristics and obstetric history which increase the risk of detecting a short cervix at 22-24 weeks.

Relation of cervical length at 22-24 weeks of gestation to demographic characteristics and obstetric history.

Preterm delivery is the main cause of neonatal death and ultrasonographic cervical assessment has been shown to be more accurate than digital examination in recognizing a short cervix. This is a cross-sectional study, involving 1131 women at 22-24 weeks of pregnancy, designed to determine the distribution of cervical length and to examine which variables of demographic characteristics and obstetric history increase the risk of a short cervix (15 mm or less). The distribution of maternal demographic and obstetric history characteristics among patients with cervical length pound 15 mm was analyzed and compared to the findings for the general population. Risk ratios (RR) between subgroups were generated from this comparison. Median cervical length was 37 mm and in 1.5% of cases it was 15 mm or less. The proportion of women with a short cervix (< or =15 mm) was significantly higher among patients with a low body mass index (RR = 3.5) and in those with previous fetal losses between 16-23 weeks (RR = 33.1) or spontaneous preterm deliveries between 24-32 weeks (RR = 14.1). We suggest that transvaginal sonographic measurement of cervical length be performed as part of a routine midtrimester ultrasound evaluation. There are specific variables of demographic characteristics and obstetric history which increase the risk of detecting a short cervix at 22-24 weeks.

Endometrial response to a cyclic regimen of percutaneous 17beta-estradiol and low-dose vaginal micronized progesterone in women with mild-to-moderate hypertension.

Endometrial response to natural estradiol and low-dose vaginal progesterone replacement therapy was evaluated in 20 postmenopausal women with chronic, mild-to-moderate hypertension. A cyclic hormone replacement therapy (HRT) regimen was used (21/28 days) with percutaneous estradiol (1.5 mg/day) and vaginal micronized progesterone (100 mg/day). Menopausal symptoms decreased and estradiol concentrations increased substantially and remained in the physiological range throughout treatment. Serum gonadotropin concentrations decreased significantly (p < 0.001, Friedman's ANOVA). Bone mineral density increased by 2.1% (p = 0.029) only at the lumbar spine. Endometrial thickness remained unchanged. Breakthrough bleeding or spotting occurred in 18% of cycles in the first 3 months of HRT, 30% in months 4-9 and 22% in months 10-12. Withdrawal bleeding occurred in 40% of cycles in the first 3 months and decreased to 25% in months 10-12. At month 12, there were 11 women with amenorrhea due to endometrial atrophy. Nine women had active endometria (proliferative or secretory) and thus reported vaginal bleeding. No severe bleeding, hyperplasia, or carcinoma was found. Vaginal bleeding was tolerated, and no subject withdrew from the study. Results suggest that this regimen confers endometrial protection and is well tolerated, and can therefore safely be used for at least 1 year by postmenopausal women with hypertension and menopausal symptoms.

Biochemical profile of amniotic fluid for the assessment of fetal and renal development.

Creatinine plays a key role in the function and maturation of fetal kidneys throughout pregnancy. It is important to identify other markers that may help in the diagnosis of renal dysfunction. Our aim was to determine the profile of and the correlation between biochemical markers to be used to assess renal function and maturation of the fetus in the amniotic fluid during pregnancy and to determine the distribution of normal values for creatinine, N-acetyl-beta-D-glucosaminidase (NAG), beta2-microglobulin, glucose, urea, sodium, potassium, phosphorus, calcium, uric acid, albumin, and osmolality in three gestational age groups. This was a cross-section study that assessed 115 samples of amniotic fluid during three different periods of pregnancy, i.e., 13 to 20, 27 to 34, and 36 to 42 weeks. Concentrations of creatinine, NAG, urea, potassium and uric acid increased during pregnancy (P<0.05). Beta2-microglobulin, glucose, sodium, phosphorus, calcium, and albumin concentration and osmolality decreased (P<0.05), whereas beta2-microglobulin, glucose and uric acid presented significant correlations with gestational age and creatinine, respectively (r>0.6, P<0.05). Urea, potassium and phosphorus showed mild correlations with both (r>0.5, P<0.05). NAG, sodium, albumin and osmolality did not show significant correlations (r<0.5, P<0.05). These tests confirmed the important role of creatinine in terms of correlation with gestational age. beta2-Microglobulin, glucose and uric acid were significant as markers of function and maturation of fetal kidneys, whereas NAG did not demonstrate a useful role for the assessment of renal maturation.

Biochemical profile of amniotic fluid for the assessment of fetal and renal development

Creatinine plays a key role in the function and maturation of fetal kidneys throughout pregnancy. It is important to identify other markers that may help in the diagnosis of renal dysfunction. Our aim was to determine the profile of and the correlation between biochemical markers to be used to assess renal function and maturation of the fetus in the amniotic fluid during pregnancy and to determine the distribution of normal values for creatinine, N-acetyl-ß-D-glucosaminidase (NAG), ß2-microglobulin, glucose, urea, sodium, potassium, phosphorus, calcium, uric acid, albumin, and osmolality in three gestational age groups. This was a cross-section study that assessed 115 samples of amniotic fluid during three different periods of pregnancy, i.e., 13 to 20, 27 to 34, and 36 to 42 weeks. Concentrations of creatinine, NAG, urea, potassium and uric acid increased during pregnancy (P<0.05). ß2-Microglobulin, glucose, sodium, phosphorus, calcium, and albumin concentration and osmolality decreased (P<0.05), whereas ß2-microglobulin, glucose and uric acid presented significant correlations with gestational age and creatinine, respectively (r>0.6, P<0.05). Urea, potassium and phosphorus showed mild correlations with both (r>0.5, P<0.05). NAG, sodium, albumin and osmolality did not show significant correlations (r<0.5, P<0.05). These tests confirmed the important role of creatinine in terms of correlation with gestational age. ß2-Microglobulin, glucose and uric acid were significant as markers of function and maturation of fetal kidneys, whereas NAG did not demonstrate a useful role for the assessment of renal maturation

Prenatal diagnosis of a benign facial tumor.

We report a case of prenatal diagnosis of a benign fetal skin tumor on the chin made at 27 weeks of pregnancy by ultrasound scan. We report this case given the uncommon diagnosis and the unique fetal facial profile seen on ultrasound, resembling the image of an ancient Egyptian pharaoh which made us call it 'Ramses' sign' as a future mnemonic aid to sonographers.

[Alpha-fetoprotein: normal values in amniotic fluid between 14 and 21 weeks]. / Alfafetoproteína: valores normais no líquido amniótico entre 14 e 21 semanas.

BACKGROUND: To define the normal values of amniotic fluid alphafetoprotein in pregnant women, whose gestational ages range from 14 to 21 weeks, in the Hospital de Clínicas de Porto Alegre. MATERIAL AND METHOD: One hundred thirty seven women with indication for amniocentesis were studied. The alphafetoprotein was measured in all samples using enzyme immunoassay. One hundred and nine normal pregnancies were selected. All of these fetuses had normal karyotype and had no malformation. They were not twins and their amniotic fluid samples were not bloody. These samples were divided by their gestational ages. Then the medians of the alphafetoprotein values and their multiples were calculated. RESULTS: The medians of alphafetoprotein (KUI/ml) for each gestational age were as follows: 14 weeks: 16.32; 15 weeks: 14.36; 16 weeks: 13.43; 17 weeks: 10.93; 18 weeks: 8.22; 19 weeks: 7.35; 20 weeks: 5.62; 21 weeks: 4.47. CONCLUSION: The establishment of alphafetoprotein normal values in our service allows us to use this assay for patients at risk of neural tube defects. It also makes possible to analyze samples sent for cytogenetic or metabolic studies, in order to identify elevated levels of alphafetoprotein, so that these fetuses could have a more detailed sonography study to look for malformations.

Alfafetoproteína: valores normais no líquido amniótico entre 14 e 21 semanas / Alphafetoproteín: amniotic fluid normal values between 14 and 21 weeks

Objetivo. Definir uma curva de normalidade dos valores de alfafetoproteína (AFP) no líquido amniótico em gestantes entre 14 e 21 semanas de gravidez no Hospital de Clínicas de Porto Alegre. Materiais e Métodos. Nas 137 mulheres que procuraram o diagnóstico pré-natal e tiveram indicaçao de coleta de líquido amniótico. A alfafetroproteína foi dosada em todas as amostras por enzima imunoensaio. Foram selecionadas 109 gestaçoes normais (sem malformaçoes, cariótipo normal, nao-gemelares) e cujas amostras de líquido amniótico nao eram sanguinolentas. Essas foram divididas quanto à idade gestacional e tiveram calculadas as medianas dos valores de AFP e seus múltiplos. Resultados. As medianas da alfafetoproteína (KUI/ml) para cada idade gestacional foram as seguintes: 14 semanas: 16,32; 15 semanas: 14,36; 16 semanas: 13,43; 17 semanas: 10,93; 18 semanas: 8,22; 19 semanas: 7,35; 20 semanas: 5,62; 21 semanas: 4,47. Conclusao. O estabelecimento de uma curva normal de AFP em nosso serviço permite a utilizaçao deste exame para pacientes em risco de defeitos de fechamento de tubo neural. Permite também que sejam analisadas amostras enviadas para estudos citogenéticos ou metabólicos de maneira a identificar fetos com níveis elevados de AFP que necessitarao de estudos ultrasonográficos mais detalhados pela possibilidade de defeitos morfológicos.

The Mars Pathfinder atmospheric structure investigation/meteorology (ASI/MET) experiment.

The Mars Pathfinder atmospheric structure investigation/meteorology (ASI/MET) experiment measured the vertical density, pressure, and temperature structure of the martian atmosphere from the surface to 160 km, and monitored surface meteorology and climate for 83 sols (1 sol = 1 martian day = 24.7 hours). The atmospheric structure and the weather record are similar to those observed by the Viking 1 lander (VL-1) at the same latitude, altitude, and season 21 years ago, but there are differences related to diurnal effects and the surface properties of the landing site. These include a cold nighttime upper atmosphere; atmospheric temperatures that are 10 to 12 degrees kelvin warmer near the surface; light slope-controlled winds; and dust devils, identified by their pressure, wind, and temperature signatures. The results are consistent with the warm, moderately dusty atmosphere seen by VL-1.

Relevance of the determination of ovarian volume in adolescent girls with menstrual disorders.

Pelvic ultrasound and hormonal studies were performed in 29 adolescent patients, aged 12 to 20 years, to evaluate menstrual irregularities. Patients were divided in three groups according to ultrasound ovarian volumes: group I (n = 16) both ovaries < 10 cm3; group II (n = 8) one of the ovaries > or = 10 cm3; and group III (n = 5) both ovaries > or = 10 cm3. Serum levels of LH, LH:FSH ratio, testosterone, and androstenedione were significantly higher (p < .05) in group III. Positive predictive value of both ovarian volumes > or = 10 cm3 in terms of polycystic ovary syndrome (PCOS) was 100%, negative predictive value was 81%, sensitivity was 63%, specificity was 100%. These data suggest that, in adolescent patients with menstrual disorders, bilateral ovarian volumes of higher than 10 cm3 are correlated with the diagnosis of PCOS.

Association of ovarian volume and serum LH levels in adolescent patients with menstrual disorders and/or hirsutism.

Pelvic ultrasonography was performed on 25 adolescent patients with menstrual disorders and/or hirsutism. Clinical and endocrinologic state was evaluated by history, physical examination and assays of serum LH, FSH, prolactin, testosterone and androstenedione levels in order to determine a possible association between hormonal levels and ovarian volume in the etiologic investigation of these adolescent girls. Patients aged 12 to 19 years, mean 14.92 years (menarche at 12 to 16 years; mean, 12.32 years) were divided into three groups according to ovarian size at ultrasonography: group I, N = 13, both ovaries 2-10 cm3; group II, N = 5, one of the ovaries > 10 cm3; group III, N = 7, both ovaries > 10 cm3. A strong correlation between serum LH levels and ovarian volume (r = 0.647, P < 0.0001) was observed. Moreover, when comparing the hormonal levels of all three groups, serum LH levels were significantly higher in group III (group I, 3.92 +/- 3.49; group II, 5.25 +/- 2.71; group III, 9.77 +/- 3.11 mIU/ml; mean +/- SD, P < 0.003) while testosterone and androstenedione levels showed a tendency to also be higher, but this difference was not significant. This hormonal pattern is suggestive of polycystic ovary syndrome (PCOS). The present results suggest that ovarian size of more than 10 cm3 at pelvic ultrasound in adolescent girls with menstrual disorders and/or hirsutism might be predictive of PCOS and emphasize the importance of careful assessment of ovarian volume by ultrasound.

Association of ovarian volume and serum LH levels in adolescent patients with menstrual disorders and/or hirsutism

Pelvic ultrasonography was performed on 25 adolescent patients with menstrual disorders and/or hirsutism. Clinical and endocrinologic state was evaluated by history, physical examination and assays of serum LH, FSH, prolactin, testosterone and androstenedione levels in order to determine a possible association between hormonal levels and ovarian volume in the etiologic investigation of these adolescent girls. Patients aged 12 to 19 years, mean 14.92 years (menarche at 12 to 16 years; mean, 12.32 years) were divided into three groups according to ovarian size at ultrasonography: group I, N = 13, both ovaries 2-10 cm3; group II, N = 5, one of the ovaries > 10 cm3; group III, N = 7, both ovaries > 10 cm3. A strong correlation between serum LH levels and ovarian volume (r = 0.647, P < 0.0001) was observed. Moreover, when comparing the hormonal levels of all three groups, serum LH levels were significantly higher in group III (group I, 3.92 +/- 3.49; group II, 5.25 +/- 2.71; group III, 9.77 +/- 3.11 mIU/ml; mean +/- SD, P < 0.003) while testosterone and androstenedione levels showed a tendency to also be higher, but this difference was not significant. This hormonal pattern is suggestive of polycystic ovary syndrome (PCOS). The present results suggest that ovarian size of more than 10 cm3 at pelvic ultrasound in adolescent girls with menstrual disorders and/or hirsutism might be predictive of PCOS and emphasize the importance of careful assessment of ovarian volume by ultrasound

Neptune's Wind Speeds Obtained by Tracking Clouds in Voyager Images.

Images of Neptune obtained by the narrow-angle camera of the Voyager 2 spacecraft reveal large-scale cloud features that persist for several months or longer. The features' periods of rotation about the planetary axis range from 15.8 to 18.4 hours. The atmosphere equatorward of -53 degrees rotates with periods longer than the 16.05-hour period deduced from Voyager's planetary radio astronomy experiment (presumably the planet's internal rotation period). The wind speeds computed with respect to this radio period range from 20 meters per second eastward to 325 meters per second westward. Thus, the cloud-top wind speeds are roughly the same for all the planets ranging from Venus to Neptune, even though the solar energy inputs to the atmospheres vary by a factor of 1000.