Cognitive and psychological factors associated with severe insomnia in Brazilian women: a cross-sectional study.

Insomnia is the most prevalent sleep disorder in women. Sociodemographic, cognitive, and psychological factors may contribute to its severity. This study evaluated factors associated with severe insomnia in women with insomnia complaints. We evaluated 530 women aged 18-59 (mean = 40.5, SD = 10.2), who experienced insomnia complaints, using self-report instruments. Severe insomnia was defined as a score above 21 on the Insomnia Severity Index. Age, marital status, educational level, depression and anxiety, psychological inflexibility, and beliefs about sleep were assessed as potential factors associated with severe insomnia. Simple and multivariate analyses were conducted using binary logistic regression. Low education level (odds ratio; OR = 1.85 [1.27-2.69]), depression (OR = 2.17 [1.27-3.81]), psychological inflexibility (OR = 1.05 [1.02-1.08]), and dysfunctional beliefs about sleep (OR = 1.04 [1.02-1.06]) were factors associated with severe insomnia scores in the multiple logistic regression model. These findings are important from a public health perspective, because behavioral strategies designed to treat insomnia with a focus on cognitive and psychological factors are low-cost treatments and may help improve sleep quality in women, which also influences mental health.

Sexsomnia: case based classification and discussion of psychosocial implications.

We describe a 42-year-old married woman diagnosed with sexsomnia as a NREM parasomnia, who sought medical assistance motivated by relationship problems with her husband after two sexsomnia episodes. This is the second case of sexsomnia reported in Brazil, but the first case with comprehensive follow-up. The patient was clinically evaluated, no psychiatric history was found, and she denied using pharmaceutical or recreational drugs. A video-polysomnography documented nine episodes of short- lasting abrupt awakening from N2 and N3, indicating a non-REM parasomnia, some with masturbation characteristics. The findings of this case, including unusual features, are considered in regard to the range of adverse psychosocial consequences of sexsomnia in these patients and the need for specialized interventions that can be provided by sleep specialists. We discuss the misinformation and delay of proper diagnosis and treatment that occurs with sexsomnia and emphasize the importance of understanding the broad set of problems and consequences related to sexsomnia, including physical, psychological, marital/relationship and at times legal aspects that affect the lives of sexsomniac patients and their bed partners.

False positive results using calcitonin as a screening method for medullary thyroid carcinoma.

The role of serum calcitonin as part of the evaluation of thyroid nodules has been widely discussed in literature. However there still is no consensus of measurement of calcitonin in the initial evaluation of a patient with thyroid nodule. Problems concerning cost-benefit, lab methods, false positive and low prevalence of medullary thyroid carcinoma (MTC) are factors that limit this approach. We have illustrated two cases where serum calcitonin was used in the evaluation of thyroid nodule and rates proved to be high. A stimulation test was performed, using calcium as secretagogue, and calcitonin hyper-stimulation was confirmed, but anatomopathologic examination did not evidence medullar neoplasia. Anatomopathologic diagnosis detected Hashimoto thyroiditis in one case and adenomatous goiter plus an occult papillary thyroid carcinoma in the other one. Recommendation for routine use of serum calcitonin in the initial diagnostic evaluation of a thyroid nodule, followed by a confirming stimulation test if basal serum calcitonin is showed to be high, is the most currently recommended approach, but questions concerning cost-benefit and possibility of diagnosis error make the validity of this recommendation discussible.

Síndrome de Cushing como complicação do tratamento de líquen plano oral erosivo / Cushing´s Syndrome as a complication of treatment of oral lichen planus

O líquen plano oral (LPO) é uma doença mucocutânea inflamatória crônica relacionada com alterações na imunidade mediada por células T. Diversos medicamentos têm sido utilizados no tratamento desta doença, especialmente nas formas erosivas e ulcerativas, com resultados variados. O objetivo deste trabalho é descrever e discutir um caso clínico de líquen plano oral erosivo tratado com corticóide sistêmico que resultou em Síndrome de Cushing, que se manteve com o uso de corticóide tópico.

Oral lichen planus (OLP) is a chronic mucocutaneous inflammatory disease involving T cells-mediated immunity. Several drugs have been used to treat OLP, specially the erosive and ulcerative forms, with varying results. The aim of this paper was to describe and discuss one clinical case of erosive oral lichen planus treated with systemic corticosteroids that resulted in Cushing´s syndrome that maintained with topical corticosteroid.

Pituitary tumor apoplexy.

Pituitary tumor apoplexy is a medical emergency due to acute infarction or hemorrhage in the pituitary gland. In this review, the authors discuss the sellar anatomy, the pituitary gland and adenomas' vascularization and the general aspects of the syndrome such as its ethiopatogenesis, predisposing factors, clinical features, treatment and prognosis.

Pituitary tumor apoplexy / Apoplexia em tumor hipofisário

Pituitary tumor apoplexy is a medical emergency due to acute infarction or hemorrhage in the pituitary gland. In this review, the authors discuss the sellar anatomy, the pituitary gland and adenomas' vascularization and the general aspects of the syndrome such as its ethiopatogenesis, predisposing factors, clinical features, treatment and prognosis.

A apoplexia em tumor hipofisário é uma emergência médica decorrente do infarto agudo ou hemorrágico na glândula hipófise. Nesta revisão os autores discutem a anatomia da região selar, a vascularização da hipófise e adenomas hipofisários, e demais aspectos da síndrome como etiopatogenia, fatores predisponentes, quadro clínico, tratamento e prognóstico.

Thymus hyperplasia after resolution of hypercortisolism in ACTH-dependent Cushing's syndrome: the importance of thymic vein catheterization.

Thymic hyperplasia has been described after the resolution of hypercortisolism from several etiologies, causing great diagnostic dilemmas. We describe a case where the catheterization of the thymic vein was essential for the differential diagnosis of a thymic enlargement in an adrenalectomized patient with ACTH-dependent Cushing's syndrome. The patient was a 48-year-old female with clinical and laboratorial data suggesting Cushing's disease. She underwent a transsphenoidal surgery with no tumor visualization and no remission of the syndrome. Histopathological studies disclosed a normal pituitary. She underwent a bilateral adrenalectomy and 8 months later a chest CT showed an increase of left thymic lobe, which was previously non-existent. After a negative (111)In-pentetreotide scintigraphy, the patient underwent simultaneous and bilateral catheterism of the petrosus sinuses and catheterization of the thymic and inominate veins and no ACTH gradient was shown among the sites of collection. She did not undergo thoracotomy and a follow-up was established. During the evolution, there was a spontaneous regression of the thymic lesion 38 months after the diagnosis. The ACTH gradient during the catheterization of thymic vein was essential for the differential diagnosis of the thymic enlargement tumor after hypercortisolism resolution in ACTH-dependent Cushing's syndrome, especially in this case, where the ACTH source was occult, thus avoiding an invasive surgical procedure for a benign entity with spontaneous resolution.

Identificação de genes diferencialmente expressos em tecido de paratireóide de pacientes portadores de hiperparatireoidismo primário: comparação entre hiperplasias, adenomas e carcinomas / Identification of differentially expressed genes in parathyroid tissue: comparison among hyperplasias, adenomas and carcinomas

Para identificar genes diferencialmente expressos em tecido de paratireóide, foram construídos painéis gênicos e utilizou-se a metodologia RDA . Foram isolados 13 genes que tiveram sua expressão analisada por PCR semiquantitativa em 33 amostras de tecido de pacientes portadores de hiperparatireoidismo primário, incluindo adenomas, carcinomas e hiperplasias. Os genes PTK7, RET e RAF parecem ter importante papel nos mecanismos tumorigênicos desta glândula / In order to identify differentially expressed genes in parathyroid tissue, gene panels were performed and RDA method was employed. Thirteen genes were isolated and had their expression analyzed by semi quantitative PCR in 33 tissue samples of patients with primary hyperparathyroidism, including adenomas, carcinomas and hyperplasias. The genes PTK7, RET and RAF may play an important role in the molecular mechanisms of parathyroid tumors...