Prevalence of endometriosis in women with systemic lupus erythematosus and Sjogren's syndrome.

Endometriosis is associated with a number of immunologic alterations. It has been suggested that autoimmune disorders could be more frequent in patients with endometriosis. The aim of this study is to ascertain whether the prevalence of two well-known autoimmune diseases [systemic lupus erythematosus (SLE) and Sjögren's syndrome (SS)] is increased in women with endometriosis. The clinical charts of four different populations assisted at the same hospital were manually revised: (i) SLE population (n = 120), (ii) SS (n = 22), (iii) endometriosis (n = 342) and (iv) control population (n = 501 consecutive unselected asymptomatic women). Among SLE women, the prevalence of endometriosis was 1.67% (2/120), similar to the 4.39% prevalence of the control group (22/501), the OR being 0.37 [95%CI 0.09-1.59]. Among SS women, the prevalence of endometriosis was 9.09 (2/22), also similar to the control group OR 2.17 [95%CI 0.48-9.90]. In the same way, when comparing endometriosis cases with asymptomatic women, similar frequencies of SLE (0.58% and 0.2%) and SS were found (0% and 0%). Women with endometriosis do not have an increased prevalence of SLE or SS.

Aplasia cutis congénita y feto papiráceo en embarazo gemelar monocoriónico / Aplasia cutis congenita with fetus papyraceus in a monochorionic twin pregnancy

Presentamos un caso clínico de aplasia cutis congénita en un recién nacido de un embarazo gemelar monocoriónico con feto papiráceo a las 14 semanas. Una revisión de la bibliografía parece soportar la hipótesis de que la existencia del feto papiráceo pueda ser la causa de esta patología en el neonato, consecuencia del “síndrome de embolización gemelar”

We report a case of aplasia cutis congenita in one twin of a monochorionic twin pregnancy with fetus papyraceus at 14 weeks. A review of the literature seems to support the hypothesis that the fetus papyraceus could be the cause of this entity in the neonate as a consequence of “twin embolization syndrome”

Accidente por rayo durante la gestación con supervivencia materna y fetal / Lightning injury during pregnancy with maternal and fetal survival

Se presenta el caso clínico de una gestante que en la semana 18 de gestación sufrió un accidente eléctrico por rayo. Tanto la evolución del embarazo como el resultado perinatal cursaron dentro de la normalidad

We present the case of an 18-week pregnant woman who was struck by lightning. The prenatal course and perinatal outcome were normal

Resultados perinatales en gestaciones triples. Estudio de 90 casos / Perinatal results in triplet gestations. A study of 90 cases

Objectives. To analyze the perinatal results of 90 triplet pregnancies attended in the Hospital de Cruces (Vizcaya) during the last 15 years. Material and methods. From January 1989 until December 2003 there were a total of 78 566 deliveries, of which 90 were triplets. We make a retrospective study of these pregnancies. Results. The incidence of triplet pregnancies has increased noticeably in recent years, increasing from 0.5 ‰ in 1989 to 3 ‰ in 2002. The main complication of these pregnancies was pre-term labour (45.6%), with an average hospital admission of 12.4 ± 13.9 days (range 1-60 days). Mean gestational age at delivery was 34 ± 2.9 weeks, with a pre-maturity level of 86.6%. The average weight of the newborns was 1795 ± 506, 1890 ± 513 and 1795 ± 517 grams respectively for the first, second and third fetus. Of the newborns, 6.28% weighed less than 1000 grams. All cases of perinatal mortality (18.5%) were in this group of newborns who weighed less than 1000 grams. Conclusion. The level of pre-maturity is the main complication to remember when making any prognostic on triplet pregnancies, and is the main influence for perinatal results (AU)

Objetivos. Analizar los resultados perinatales de los 90 embarazos triples atendidos durante los últimos 15 años en el Hospital de Cruces (Vizcaya). Material y métodos. Desde enero de 1989 hasta diciembre de 2003 se ha atendido un total de 78.566 partos. De ellos, 90 fueron partos triples. Estudiamos de forma retrospectiva los resultados perinatales de estos embarazos. Resultados. La incidencia de embarazos triples se ha incrementado notablemente en los últimos años, que pasó del 0,5‰, en 1989, al 3‰, en 2002. La principal complicación de estas gestaciones fue la amenaza de parto pretérmino (45,6%), con un tiempo medio de hospitalización por este proceso de 12,4 ± 13,9 días (rango, 1-60 días). La edad media en el momento del parto fue de 34 ± 2,9 semanas, con una tasa de prematuridad del 86,6%. El peso medio de los recién nacidos fue de 1.795 ± 506, 1.890 ± 513 y 1.795 ± 517 g, respectivamente, para el primero, segundo y tercer feto. El 6,28% de los recién nacidos nació con un peso inferior a 1.000 g. Todos los casos de mortalidad perinatal (18,5‰) se centraron en este grupo de recién nacidos de peso < 1.000 g. Conclusión. La tasa de prematuridad es la principal complicación a tener en cuenta a la hora de dar un pronóstico a los embarazos triples y la que más condiciona los resultados perinatales (AU)

Adenosarcoma ovárico con componente heterólogo / Ovarian adenosarcoma with a heterologous component

El adenosarcoma mülleriano es un tumor bifásico constituido por un componente glandular benigno, ocasionalmente con atipias, asociado a un componente mesenquimal maligno. El adenosarcoma ovárico tiene un peor pronóstico que su homónimo uterino. En dos tercios de los casos se produce recidiva tumoral y casi siempre en los primeros 5 años tras el diagnóstico. En pacientes en estadio I, la edad menor a 53 años, la rotura tumoral, el alto grado y el sobrecrecimiento estromal se asocian a una alta tasa de recidiva. Presentamos un caso de adenosarcoma ovárico en estadio Ia diagnosticado en nuestro centro, con recidiva precoz, y revisamos la bibliografía (AU)

Mullerian adenosarcoma is a bifasic tumour composed of a benign glandular component, occasionally with atypical cells, associated with a malignant mesenchymal component. The sarcomatous portion of the adenosarcoma may vary from low to very high grade, and its clinical behavior may be inactive or aggressive. Generally they originate in the uterus. Extrauterine sites are infrequent, but may be in the ovaries, fallopian tubes or the peritoneal mesothelium. We describe a case of ovarian adenosarcoma with early pelvic recurrence, and review the literature (AU)

Adenosarcoma uterino. Nuestra casuística / Uterine adenosarcoma. Our experience

El adenosarcoma uterino es un tumor mixto, poco frecuente, que histológicamente se caracteriza por un componente epitelial benigno asociado a un componente mesenquimal sarcomatoso. El síntoma clásico de presentación es la hemorragia vaginal ocasionalmente asociada a dolor pélvico. El tumor presenta un bajo potencial maligno, pero requiere seguimiento clínico a largo plazo. Presentamos los 2 casos de adenosarcoma uterino diagnosticados en nuestro hospital en los últimos 10 años (AU)

Effect of hypocaloric meals with different macronutrient compositions on energy metabolism and lung function in obese women.

OBJECTIVE: We investigated the effect of hypocaloric mixed diets with different proportions of carbohydrate, protein, and fat on resting metabolic rate and the thermic effect of food in obese women. METHODS: Three mixed hypocaloric diets were consumed in random order during separate periods lasting 7 d each. Between each dietary period there was a washout period of 10 d. Diet 1 had a higher proportion of energy from carbohydrate (72%), diet 2 had a higher proportion of energy from protein (43%), and diet 3 had a higher proportion of energy from fat (68%). Indirect calorimetry and lung function tests were done after the completion of each 7-d diet. Seven obese women, ages 22 to 45 y and with body mass indexes of 32 to 59 kg/m(2), participated in the study. Oxygen consumption, carbon dioxide production, resting metabolic rate, and the thermic effect of food by indirect calorimetry were measured. Lung function tests included spirometry in the seated and upright positions, arterial blood gas analysis, and maximal inspiratory and expiratory pressures. RESULTS: There were no statistically significant differences in the resting metabolic rate and the thermic effect of food resulting from the three diets. The mean resting metabolic rates (kJ/d) were 7453 +/- 1446 for diet 1, 7461 +/- 1965 for diet 2, and 7076 +/- 2048 for diet 3. The mean thermic effects of food (kcal/min) were -0.02 +/- 0.07 for diet 1, -0.01 +/- 0.25 for diet 2, and 0.05 +/- 0.13 for diet 3. Lung function tests were normal before and after the hypocaloic diets: partial pressure of oxygen (mmHg) values were 81 +/- 13, 77 +/- 8, and 78 +/- 11 for diets 1 to 3, respectively; and partial pressure of carbon dioxide (mmHg) were 37 +/- 4, 37 +/- 3, and 37 +/- 4 for diets 1 to 3, respectively. CONCLUSIONS: Obese women with normal lung function tests and consuming mixed hypocaloric diets showed no alteration in resting metabolic rate and a reduced or absent thermic effect of food independently of the macronutrient composition.

Serum levels assessment of vitamin A, E, C, B2 and carotenoids in malnourished and non-malnourished hospitalized elderly patients.

AIMS & METHODS: Serum levels of vitamins A, E, C, B2 and carotenoids were determined in protein-energy malnourished (PEM, with body mass index, BMI<18.5 kg/m2) and non-PEM (BMI+/-18.5 kg/m2) hospitalized elderly (age > or = 65 years) patients, in the University Hospital of Faculty of Medicine of Ribeirão Preto, São Paulo University. RESULTS: PEM (n=21) and non-PEM (n=106) patients were paired for age (73.6+/-7.3 vs. 71.6+/-5.6 years) and male percentage (65.1 vs. 52.4%). As expected, PEM elderly showed lower (P<0.05) body weight (median 43.1; range: 29.9-51.4 vs. 58.1; range: 45.7-143.5 kg), triceps skinfold (5.2+/-3.1 vs. 10.1+/-4.9 mm), and mid-arm muscle circumference (20.3+/-2.5 vs. 23.1+/-3.4 cm). Serum albumin (4.0+/-0.9 vs. 4.1+/-0.7 g/dl) and total lymphocytes count (1918.3+/-919 vs. 1842.7+/-862 mm(3)) were similar, respectively, among PEM and non-PEM patients. The percentage of biochemical riboflavin deficiency (58.8 vs. 56.2), low serum levels of vitamin A (28.6 vs. 29.6) and vitamin E (18.7 vs. 25) were similar, respectively, between PEM and non-PEM groups. The prevalence of low serum levels of water soluble vitamins was higher (P<0.01) in malnourished elderly than in the non-PEM group (ascorbic acid, 80.9 vs. 56.7%, and carotenoids, 14.3 vs. 3%, respectively). CONCLUSIONS: These results suggest that hospitalized malnourished elderly show high percentage of low water soluble vitamin serum levels, a phenomenon possibly linked to decreased food intake, especially fruits and vegetables.

[Malnutrition and hypovitaminosis A in AIDS patients]. / Subnutrição e hipovitaminose A em pacientes com AIDS.

Anthropometric measurements and biochemical determinations were performed on HIV-infected individuals and on patients with AIDS from the Ribeirão Preto region, SP, Brazil, in order to evaluate their nutritional and vitamin A status. Plasma retinol was measured by HPLC, and hepatic vitamin A stores were evaluated by the relative dose response (RDR) test. Patients with AIDS presented significant undernutrition, with more marked alterations in the body fat compartment and a relative preservation of the parameters related to muscle mass (pattern of malnutrition predominantly of the marasmus type). Plasma retinol values below 1.05 mumol/L were observed in 25% of the patients with AIDS and in 17.3% of HIV-infected patients and RDR values indicating low body stores of vitamin A were detected in 28% of the subjects. There was no correlation between serum retinol levels and CD4 lymphocyte counts, clinical diagnosis of AIDS, low BMI or AFI. On the other hand, hypovitaminosis A status was associated with low BMI.

Paludismo y embarazo / Paludismo and pregnancy

Estudia los casos de malaria en embarazadas en el período comprendido entre 1990-1995 en el Hospital Gineco-Obstétrico Enrique C. Sotomayor, las principales complicaciones fueron: anemia, hipoglicemia, aborto y prematuridad. La tasa de mortalidad fue del 4xciento, las causas fueron encefalopatía y coma; la quimioprofilaxis y las medidas de protección personal en mujeres embarazadas deben ser tomadas para reducir los riesgos tanto en la madre como en el feto...

Effect of local diets with added sucrose on glycemic profiles of healthy and diabetic Brazilian subjects.

OBJECTIVE: We set out to determine the daily glycemic profile of healthy and non-insulin-dependent diabetes mellitus (NIDDM) persons and to test the hypothesis that small amounts of sucrose added to NIDDM meals would not change their responses. METHODS: Thirteen NIDDM and six healthy volunteers participated in the study. They initially consumed a diet similar to their home diet and later a diabetic hospital dietary regimen, with and without 30 g/day sugar replacing equivalent food energy. The hospital diet included their usual foods: bread, milk, rice, beans, meat, vegetables and fruits at breakfast, lunch and dinner. To follow their glycemic profile we drew several blood samples during a 22-hour period. RESULTS: The day-long plasma glucose profile of the NIDDM and healthy subjects showed similar patterns, increasing after the meals and returning later to baseline levels. The extra amount of sucrose consumed did not change the daily glycemic profile or the calculated glycemic area under the 22-hour glycemic curves. These results call attention to the importance of the 22-hour glycemic profile compared to other shorter glycemic indexes. CONCLUSION: The 22-hour profile has obvious advantage for planning day-long diabetic diets, taking in consideration local daily foods and usual eating habits. Maintenance of a small and traditional amount of food, e.g., sucrose, without harmful effects to the subjects, is another advantage of this proposition. It improves patient compliance as well as social daily life.

Síndrome do intestino curto: aspectos fisiopatológicos, clínicos e suporte nutricional de longa duraçäo / Short bowel syndrome: physiopathological and clinical aspects, and long-term nutritional support

Os pacientes com Síndrome do Intestino Curto (SIC) necessitam de suporte nutricional parenteral, sem o que a taxa de mortalidade é superior a 80 por cento. A unidade Metabólica do Hospital de Clínicas da Faculdade de Medicina de Ribeirao Preto mantém programa de suporte nutricional parenteral em regime ambulatorial para o paciente com SIC, estabelecido de acordo com a necessidade individual de cada paciente, o que é determinado pela avaliaçao periódica do estado nutricional por meio de critérios clínicos, dietéticos, antropométricos e bioquímicos. Este artigo discute os aspectos fisiopatológicos e clínicos da SIC, bem como a conduta do suporte nutricional de longa duraçao empregada nos pacientes tratados na Unidade Metabólica do Hospital de Clínicas da Faculdade de Medicina de Ribeirao Preto.

[Serum levels of vitamin A, E, C and B2, carotenoid and zinc in hospitalized elderly patients]. / Avaliação dos níveis séricos das vitaminas A, E, C e B2, de carotenóides e zinco, em idosos hospitalizados.

Serum levels of carotenoids, zinc and vitamins A, E, C and B2 were measured in al (n = 202) the elderly patients hospitalized in different wards of the hospital studied from February 1986 to October 1988. The study was conducted on 130 men and 72 women with a mean age of 67.8 years (range: 60 to 88 years). The percentage of nutritional deficiency was 59.5% for zinc, 56.5% for vitamin C, 34.5% for vitamin B2, 25.9% for vitamin E, 13.2% for vitamin A, and 6.8% for carotenoids. Elderly patients with leucoses, megaesophagus, chronic obstructive pulmonary disease, and congestive heart failure represent a group with a high prevalence of deficiency both of zinc and of the vitamins under study. These results show the importance of detecting deficiencies of these micronutrients and provide a basis for a more rational approach to the treatment of elderly patients.

Vitamin C load test in elderly subjects.

Ascorbic acid fasting serum levels and levels after a test dose were carried out in a group of elderly subjects: nine men with 70 +/- 6 years and six women 74 +/- 7 years old. They live in the same old folks home and ate similar food. Their ascorbic acid intake was found to be around 20 mg/day. Fasting serum levels found lower values in the women. A load test showed a small increase in the hourly samples, supporting low tissue reserves of the vitamin. Factors such as low intake, absorption, metabolism, body mass and/or excretion of the vitamin in elderly population could explain these results. A marginal vitamin C deficiency is believed to be present in the group and extra ascorbic acid food supply seems to be recommended for these subjects.