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1.
Curr Opin Urol ; 30(4): 507-512, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32427629

RESUMO

PURPOSE OF REVIEW: To provide an overview of available electrical stimulation devices in neurogenic patients with lower urinary tract disease. RECENT FINDINGS: It is advocated to do more studies in neurogenic patients as results seem promising and useful but most studies did not include neurogenic patients or neurogenic patients were not analyzed or reported separately. Most studies included a small heterogenous neurogenic group with multiple pathophysiologic origin focusing on effect of a treatment instead of results of a treatment in a specific neurogenic group. Neuromodulation or stimulation has the advantage that it acts on different organs, like bladder and bowel, so can treat neurogenic patients, who mostly suffer from multiple organ failure. SUMMARY: Brindley procedure, sacral neuromodulation (SNM) and posterior tibial nerve stimulation (PTNS) are available for a while already. The Brindley procedure (including sacral anterior root stimulation in combination with a rhizotomy of posterior sacral roots) is developed for selected spinal cord injury patient with a complete spinal injury, and has shown results for many years in neurogenic patients. An alternative to the rhizotomy is not established yet. SNM and PTNS are other modalities that are used in nonneurogenic patients, but are not yet indicated and much studied in neurogenic patients.

2.
World J Urol ; 37(5): 899-906, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30155727

RESUMO

PURPOSE: To examine the functional survival of the artificial urinary sphincter (AUS) AMS800 in a changing patient population. Because of increasing experience and dexterity of the operating team, we hypothesize that patients with known risk factors nowadays have a better survival of their prosthesis. However, due to a change to a more complex case mix, overall results appear to be worse. MATERIALS AND METHODS: All men who underwent implantation of an AUS between 2001 and 2016 because of urethral sphincter deficiency were retrospectively analyzed. Patients were divided in groups based on date of surgery and number of patients: 2001-2009 (G1), 2010-2013 (G2), 2014-2016 (G3). Baseline characteristics and additional therapies prior to implantation were analyzed in all groups. Risk factors for failure only in G1 and G2. Revision or explantation of the AUS was used as endpoint. Kaplan-Meier analysis was used to calculate survival of the device. RESULTS: A total of 129 patients (mean age 72 ± 9 years) underwent 129 primary implants, and 11 secondary implants. Median follow-up was 5.74 years in G1, 3.26 years G2 and 1.54 years G3. Approximately 25% of the patients in G1 had received adjuvant therapy for prostate cancer and 14% underwent previous surgery for incontinence. In G2, 51 and 55% underwent adjuvant therapy for prostate cancer and previous surgery for incontinence, respectively, G3 was comparable. The overall 50% survival improved in patients with radiotherapy and previous incontinence surgery in G2 as compared to G1. CONCLUSIONS: Despite the more complex patient population, the survival of the AUS did not decrease. In some patient categories, the AUS functional survival is even still improving over the past few years.


Assuntos
Complicações Pós-Operatórias/cirurgia , Falha de Prótese , Incontinência Urinária por Estresse/cirurgia , Esfíncter Urinário Artificial , Idoso , Idoso de 80 Anos ou mais , Quimioterapia Adjuvante , Diabetes Mellitus/epidemiologia , Humanos , Masculino , Prostatectomia , Radioterapia Adjuvante , Estudos Retrospectivos , Fatores de Risco , Slings Suburetrais , Estreitamento Uretral/epidemiologia , Estreitamento Uretral/cirurgia , Bexiga Urinaria Neurogênica/complicações , Incontinência Urinária por Estresse/etiologia , Procedimentos Cirúrgicos Urológicos Masculinos
3.
Neth Heart J ; 22(4): 151-7, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24574313

RESUMO

BACKGROUND: Single-photon emission computed tomography (SPECT) is an important prognostic tool in evaluating coronary artery disease (CAD), with a high negative predictive value (NPV) for the occurrence of major adverse cardiac events (MACE). The prognostic value of SPECT is disputed in women, patients with atrial fibrillation (AF), diabetes, left bundle branch block (LBBB) and renal impairment. METHODS: Seven hundred sixty-two patients without prior history of CAD who had SPECT without perfusion deficits were followed for 2 years for MACE. Predictive variables for the occurrence of MACE were reviewed by Cox proportional hazard regression, considering clinical information, resting-ECG data and SPECT data. RESULTS: The NPV of SPECT for the occurrence of MACE within 2 years was 95.8 %. Multivariate Cox regression revealed male gender as the only significant predictor for the occurrence of MACE, besides a positive stress ECG at SPECT and a low LVEF. AF, LBBB, renal impairment and diabetes had no significant effect on the prognosis after normal SPECT. CONCLUSION: SPECT with normal perfusion images has great NPV in a medium-sized clinic in the Netherlands, even in patients with LBBB, AF, diabetes and renal impairment. MACE-free survival, however, was negatively influenced by male gender; we therefore propose more caution in men.

4.
Unfallchirurg ; 116(1): 47-52, 2013 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-21604027

RESUMO

BACKGROUND: The non-operative management (NOM) of blunt splenic injuries has gained widespread acceptance. However, there are still many controversies regarding follow-up of these patients. The purpose of this study was to survey active members of the Swiss Society of General and Trauma Surgery (SGAUC) to determine their practices regarding the NOM of isolated splenic injuries. MATERIALS AND METHODS: A survey of active SGAUC members with a written questionnaire was carried out. The questionnaire was designed to elicit information about personal and facility demographics, diagnostic practices, in-hospital management, preferred follow-up imaging and return to activity. RESULTS: Out of 165 SGAUC members 52 (31.5%) completed the survey and 62.8% of all main trauma facilities in Switzerland were covered by the sample. Of the respondents 14 (26.9%) have a protocol in place for treating patients with splenic injuries. For initial imaging in hemodynamically stable patients 82.7% of respondents preferred ultrasonography (US). In cases of suspected splenic injury 19.2% of respondents would abstain from further imaging. In cases of contrast extravasation from the spleen half of the respondents would take no specific action. For low-grade injuries 86.5% chose to admit patients for an average of 1.6 days (range 0-4 days) with a continuously monitored bed. No differences in post-discharge activity restrictions between moderate and high-grade splenic injuries were found. CONCLUSION: The present survey showed considerable practice variation in several important aspects of the NOM of splenic injuries. Not performing further CT scans in patients with suspected splenic injuries and not intervening in cases of a contrast extravasation were the most important discrepancies to the current literature. Standardization of the NOM of splenic injuries may be of great benefit for both surgeons and patients.


Assuntos
Padrões de Prática Médica/estatística & dados numéricos , Baço/lesões , Baço/cirurgia , Traumatologia/estatística & dados numéricos , Ultrassonografia/estatística & dados numéricos , Ferimentos não Penetrantes/diagnóstico , Ferimentos não Penetrantes/terapia , Adolescente , Coleta de Dados , Feminino , Humanos , Masculino , Médicos/estatística & dados numéricos , Prevalência , Suíça/epidemiologia , Ferimentos não Penetrantes/epidemiologia
6.
Adv Urol ; 2011: 709708, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21738530

RESUMO

The Brindley procedure consists of a stimulator for sacral anterior-root stimulation and a rhizotomy of the dorsal sacral roots to abolish neurogenic detrusor overactivity. Stimulation of the sacral anterior roots enables micturition, defecation, and erections. This overview discusses the technique, selection of patients and clinical results of the Brindley procedure. The Brindley procedure is suitable for a selected group of patients with complete spinal cord injury and detrusor overactivity. Overall, the Brindley procedure shows good clinical results and improves quality of life. However, to remain a valuable treatment option for the future, the technique needs some adequate changes to enable analysis of the implanted parts, to improve revision techniques of the implanted parts, and to abolish the sacral dorsal rhizotomy.

7.
Spinal Cord ; 49(4): 566-72, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-20921957

RESUMO

STUDY DESIGN: Experimental. OBJECTIVES: Electrical stimulation of the dorsal genital nerves (DGN) suppresses involuntary detrusor contractions (IDCs) in patients with neurogenic detrusor overactivity (DO). The feasibility of minimal invasive electrode implantation near the DGN and the effectiveness of conditional stimulation to suppress IDCs at different amplitudes in spinal cord injury (SCI) patients with DO were studied. SETTING: Radboud University Nijmegen MC, The Netherlands. METHODS: In eight healthy volunteers, a needle electrode was inserted from both a medial and lateral-to-midline site at the level of the pubic bone. Electrode insertion was guided by the genito-anal reflex (GAR) evoked by electrical stimulation and by sensation to this stimulation. In eight SCI patients with DO, the bladder was repeatedly filled and emptied partially in between. Conditional stimulation using a needle electrode was applied when an IDC was observed at urodynamics. Different amplitudes were used during each filling. Control cystometry was carried out before electrode insertion and after stimulation. RESULTS: The lateral implant approach was preferred, as it was easier to manoeuvre the needle along the pubic bone and fixate the needle. In SCI patients, the electrode was positioned successfully, and IDCs were suppressed (range 1-6 IDC suppressions) with conditional stimulation at maximum tolerable amplitude, except for one patient. Stimulation was less effective at lower amplitudes. Stimulation lowered the intensity of bladder sensations concomitant with IDC. CONCLUSION: The lateral-to-midline implant approach, in combination with GAR and sensation to stimulation, is feasible for electrode implantation near the DGN in SCI patients. Conditional stimulation effectively suppresses IDCs.


Assuntos
Terapia por Estimulação Elétrica/métodos , Traumatismos da Medula Espinal/fisiopatologia , Bexiga Urinaria Neurogênica/fisiopatologia , Bexiga Urinaria Neurogênica/terapia , Adulto , Eletrodos Implantados/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Contração Muscular/fisiologia , Traumatismos da Medula Espinal/etiologia , Bexiga Urinária/inervação , Bexiga Urinária/fisiopatologia , Bexiga Urinaria Neurogênica/etiologia , Adulto Jovem
8.
ISRN Cardiol ; 2011: 617912, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-22347647

RESUMO

Although mild hypothermia treatment is part of the standard postresuscitation care today, no standard method for treatment of accidental severe hypothermia has been yet established. Different strategies including invasive and noninvasive methods have been described in the literature. We present the case of a 75-year-old man with accidental severe hypothermia (23°C) and demonstrate that using a surface cooling device with automatic controlled temperature feedback mechanism (ArcticSun2000 Medivance, Louisville, Colorado, USA) is an effective and safe method for controlled rewarming in this life-threatening setting.

9.
Neurourol Urodyn ; 29(8): 1380-6, 2010 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-20623525

RESUMO

AIMS: Adequate urodynamic assessment of bladder behavior is essential in spinal cord injury (SCI) patients. Ambulatory urodynamics are more sensitive to detect detrusor overactivity (DO) than conventional urodynamics. The primary objective of this study was to determine the value of ambulatory urodynamics for the diagnosis of DO in SCI patients compared to conventional urodynamics. METHODS: Twenty-seven SCI patients who were suspected of DO underwent both conventional and ambulatory urodynamics at one day. A single involuntary detrusor contraction (IDC) was defined as a detrusor pressure rise of at least 10 cmH(2)O. DO according to the ICS definition was used in addition to minimize the influence of catheter artifacts. Outcome of urodynamics was used for decisions on treatment. RESULTS: Ambulatory urodynamics were more sensitive to diagnose IDC and DO. Conventional urodynamics had a sensitivity of 82% and specificity of 75% for DO diagnosis compared to ambulatory urodynamics. Mean maximum detrusor pressures did not differ significantly between both urodynamics. When the maximum detrusor pressure at conventional urodynamics did not exceed 40 cmH(2)O, 83% (10/12) of patients had a mean maximum detrusor pressure under 40 cmH(2)O at ambulatory urodynamics. Although the inter-individual DO diagnostic agreement was lower for ambulatory than conventional urodynamics (58%, K = 0.201 vs. 77%, K = 0552), the treatment agreement was higher for ambulatory urodynamics (58% vs. 42%). CONCLUSIONS: Ambulatory urodynamics do not seem necessary for diagnosis and risk assessment in SCI patients suspected for DO when conventional urodynamics are done properly. The exact role of urodynamics in treatment decision remains to be determined.


Assuntos
Traumatismos da Medula Espinal/complicações , Bexiga Urinaria Neurogênica/diagnóstico , Bexiga Urinária/inervação , Urodinâmica , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Valor Preditivo dos Testes , Pressão , Sensibilidade e Especificidade , Traumatismos da Medula Espinal/fisiopatologia , Bexiga Urinaria Neurogênica/etiologia , Bexiga Urinaria Neurogênica/fisiopatologia , Adulto Jovem
10.
Neurourol Urodyn ; 29(3): 395-400, 2010 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-19618446

RESUMO

AIMS: Conditional stimulation of dorsal genital nerves suppresses undesired detrusor contractions (UDC) and consequently increases bladder capacity and prevents incontinence. No clinically applicable sensor exists for reliable bladder activity monitoring as a trigger for conditional stimulation. Primary objective of this study was to determine whether bladder sensation concomitant with UDC may be used for spinal cord injury (SCI) patients to trigger neurostimulation in daily life. METHODS: Nineteen male and 7 female SCI patients suspected of detrusor overactivity (DO) underwent conventional and 6-hr ambulatory urodynamics. Patients were instructed to do normal daily activities and to activate event buttons of the ambulatory recorder to mark events: physical activity, bladder sensation, micturition or intermittent catheterization, and urinary incontinence. Detection rate was defined as the number of recorded bladder sensation divided by the total number of recorded UDC during ambulatory urodynamics. RESULTS: Bladder sensation was reported by 73% of patients in daily life. Only 41% of patients had analyzable bladder sensation concomitant with UDC during ambulatory urodynamics. For ambulatory and conventional urodynamics, mean detection rates were 23% and 72%, respectively, with mean recording delays of 57 and 16 sec after UDC onset, respectively. CONCLUSIONS: Bladder sensation only occurs in a small group of SCI patients combined with a rather low detection rate and long reaction time. Therefore, bladder sensation as a trigger for conditional stimulation does not seem to be suitable for SCI patients with DO. Reliable techniques for chronic bladder activity monitoring are a prerequisite for successful clinical application of conditional stimulation.


Assuntos
Sensação , Traumatismos da Medula Espinal/fisiopatologia , Bexiga Urinária/fisiopatologia , Urodinâmica , Adulto , Idoso , Estimulação Elétrica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
12.
Urol Int ; 82(4): 394-8, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19506404

RESUMO

INTRODUCTION: Stress urinary incontinence is a bothersome complication of radical prostatectomy. Surgical treatment consists of the artificial urinary sphincter (AUS), the male sling and bulk injections. This study presents the results of the first series of implantations of ProACT in the Netherlands. MATERIALS AND METHODS: A non-validated questionnaire was sent to 29 male patients implanted with ProACT to determine Stamey score, pad count and questions about quality of life and satisfaction. Complications, revisions and explantations were registered. RESULTS: Mean follow-up was 41 months. Based on Stamey score four patients are continent at the end and nine patients according to the pad count. The average pad count decreased significantly. Remarkable was the high rate of dislocations and revisions and patients' satisfaction. CONCLUSIONS: ProACT is a less invasive treatment compared to the AUS. However, the procedure is associated with a substantial revision and explantation rate. ProACT can be part of a so-called step-up approach before opting for a more invasive treatment.


Assuntos
Prostatectomia/efeitos adversos , Próteses e Implantes , Incontinência Urinária por Estresse/etiologia , Incontinência Urinária por Estresse/cirurgia , Idoso , Humanos , Masculino , Satisfação do Paciente , Inquéritos e Questionários
13.
Clin Nutr ; 28(1): 15-20, 2009 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-18835506

RESUMO

BACKGROUND & AIMS: Cardiac surgery provokes an inflammatory response for which the endothelium, the myocardium, and monocytes/macrophages are primarily responsible. T cells are altered in a different way whereby the pro-inflammatory pathway is suppressed. From the results of experimental studies it was concluded that glutamine (Gln) enhances the production of T-cell cytokines in conditions of Gln deprivation. The aim of this clinical study was to evaluate the role of a perioperative Gln infusion on intracellular inflammatory T-cell cytokine expression in patients undergoing elective cardiac surgery and to evaluate the effects on systemic inflammation, organ dysfunction and ICU length of stay. METHODS: In this prospective, randomized, double-blind study, we included 78 patients (age level older than 70 years, ejection fraction less than 40%, or mitral valve replacement) undergoing elective cardiosurgery with cardiopulmonary bypass. We randomly assigned each subject to receive an infusion with either Gln (0.5 g/kg/day, group A) or an isonitrogenous, isocaloric, isovolemic nutritional solution (group B) or physiological NaCl 0.9% (group C, to eliminate an unspecific nutritional effect). We started the infusion after the induction of anesthesia with 1000 ml/24 h and maintained this state for 3 days. RESULTS: On the first postoperative day plasma Gln levels in group A were significantly increased (958 +/- 331 microM) compared to group B (527 +/- 105 microM) and group C (489 +/- 104 microM), and remained higher until the third postoperative day. At the beginning and after surgery intracellular interleukin (IL)-1, IL-6, IL-8, and tumor necrosis factor-alpha levels in T cells showed no differences between the groups. Also, no differences could be observed with regard to C-reactive protein, SOFA score, heart and circulation support, postoperative ventilation time, and ICU length of stay. CONCLUSIONS: The elevation of Gln plasma levels as a result of 0.5 g/kg/day perioperative Gln infusion has no influence on the T-cell derived inflammatory response, indicating a sufficient supply of Gln. A Gln supplementation in cardiac surgery patients without a clear Gln deficiency seems not to affect the intracellular inflammatory T-cell cytokine expression.


Assuntos
Ponte Cardiopulmonar , Citocinas/biossíntese , Glutamina/administração & dosagem , Glutamina/sangue , Inflamação/prevenção & controle , Idoso , Proteína C-Reativa/metabolismo , Citocinas/sangue , Método Duplo-Cego , Feminino , Cardiopatias/sangue , Cardiopatias/imunologia , Cardiopatias/cirurgia , Humanos , Inflamação/imunologia , Infusões Intravenosas , Tempo de Internação , Masculino , Assistência Perioperatória/métodos , Cuidados Pós-Operatórios , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos , Células Th1/efeitos dos fármacos , Células Th1/imunologia , Células Th2/efeitos dos fármacos , Células Th2/imunologia
14.
J Anal Toxicol ; 32(9): 768-73, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-19021933

RESUMO

A 49-year-old man consumed two glasses (approximately 2 x 20 mL) of a beverage containing yellow gentian (Gentiana lutea). Shortly after ingestion, he developed nausea, vomiting, and oral paraesthesia. On admission to the hospital he suffered from severe bradycardia (35 beats/min) and hypotension (50/30 mm Hg), and he was treated with activated charcoal, antiemetics (metoclopramide, ondansetron), atropine, and intravenous electrolytic solution. The initial suspicion of Veratrum poisoning could be confirmed by identifying protoveratrines A (ProA) and protoveratrine B (ProB) in a sample from the beverage as well as in the patients serum by liquid chromatography-electrospray ionization-tandem mass spectrometry (LC-ESI-MS-MS). The yellow-colored beverage contained 25% ethanol (by headspace gas chromatography), 20.4 mg/L ProA, and 13.7 mg/L ProB. The serum concentration of ProA was 1162 ng/L and ProB was 402 ng/L. Veratridine, cevadine, and jervine were not detected, neither in the beverage nor in the serum sample. The lower limits of quantitation for all compounds is 10 microg/L (S/N > 10, beverage) and 100 ng/L (S/N > 10, serum). After treatment, the patient completely recovered from the symptoms within 24 h and was discharged from the hospital. The analytical method described was developed for the simultaneous identification and quantitation of five Veratrum alkaloids. The method is based on a liquid-liquid extraction followed by LC-MS-MS analysis. The time needed for analysis was 6 min.


Assuntos
Alcaloides de Veratrum/análise , Alcaloides de Veratrum/envenenamento , Veratrum/química , Veratrum/envenenamento , Acidentes , Bebidas Alcoólicas/análise , Bebidas Alcoólicas/envenenamento , Antídotos/uso terapêutico , Antieméticos/uso terapêutico , Carvão Vegetal/uso terapêutico , Cromatografia Líquida de Alta Pressão , Cromatografia em Camada Delgada , Gentiana , Hemodinâmica/efeitos dos fármacos , Humanos , Indicadores e Reagentes , Masculino , Espectrometria de Massas , Pessoa de Meia-Idade , Espectrometria de Massas por Ionização por Electrospray , Espectrofotometria Ultravioleta
15.
Ann Clin Biochem ; 43(Pt 4): 320-2, 2006 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-16824286

RESUMO

BACKGROUND: To measure low neonatal gonadotropin levels, a sensitive non-invasive method is optimal. The aim of the current study was to validate the Architect i2000SR, an automated immunoassay analyser for the measurement of gonadotropins in unextracted neonatal urine samples against serum gonadotropin levels as a gold standard. METHODS: Blood and urine were sampled from 30 approximately six-week-old male and female neonates undergoing elective paediatric surgery. Follicle stimulating hormone (FSH) and luteinizing hormone (LH) were measured and the urine results were corrected for creatinine. RESULTS: The agreement between neonatal serum and urinary FSH was 0.904 (3-5 h between samples) and 0.704 (18-20 h). For LH, the correlation coefficients were 0.785 and 0.507, respectively. CONCLUSION: We conclude that gonadotropins can be reliably measured using the Architect on randomly voided, non-extracted urine samples collected from neonates by an adhesive device. Urinary gonadotropin levels are a proper reflection of the serum levels.


Assuntos
Gonadotropinas/sangue , Gonadotropinas/urina , Imunoensaio/métodos , Adulto , Idoso , Automação , Química Clínica/métodos , Creatinina/sangue , Feminino , Hormônio Foliculoestimulante/biossíntese , Humanos , Lactente , Recém-Nascido , Hormônio Luteinizante/biossíntese , Masculino , Pessoa de Meia-Idade , Valores de Referência , Reprodutibilidade dos Testes
16.
Ned Tijdschr Geneeskd ; 149(16): 859-65, 2005 Apr 16.
Artigo em Holandês | MEDLINE | ID: mdl-15868989

RESUMO

The metabolic syndrome is a cluster of several vascular risk factors (impaired glucose metabolism, dyslipidaemia, hypertension and central adiposity). The prevalence of the metabolic syndrome is high, varying between 10 and 40% depending on age and sex. This prevalence will increase in the years to come due to the increased prevalence of overweight/obesity. To identify the metabolic syndrome, there is a readily applicable definition for daily clinical practice, i.e. the presence of three or more of the following characteristics: hyperglycaemia, hypertension, low plasma HDL cholesterol level, high plasma triglyceride level and central adiposity. The underlying pathophysiology is not fully clarified, but insulin resistance plays an important role in this syndrome. The metabolic syndrome is associated with increased cardiovascular morbidity and mortality and an increased risk for the development of diabetes mellitus type 2. In subjects with one or two components of the metabolic syndrome and in patients with manifest vascular disease, it seems advisable to be alert to the presence of the other components in order to either diagnose or exclude the metabolic syndrome. Although clinical evidence is lacking, from a pathophysiological point of view it seems reasonable to focus the treatment on reducing insulin resistance, which can be achieved by weight reduction and an increase in physical activity. Treatment of the individual risk factors may also be considered, depending on the degree of vascular risk.


Assuntos
Doenças Cardiovasculares/epidemiologia , Síndrome Metabólica/epidemiologia , Síndrome Metabólica/etiologia , Fatores Etários , Doenças Cardiovasculares/etiologia , Diabetes Mellitus Tipo 2 , Feminino , Humanos , Hiperlipidemias , Hipertensão , Resistência à Insulina , Masculino , Síndrome Metabólica/prevenção & controle , Obesidade/complicações , Prevalência , Fatores de Risco , Fatores Sexuais
18.
Clin Exp Dermatol ; 29(1): 32-4, 2004 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-14723716

RESUMO

Drop-like, transient blisters of miliaria crystallina may develop with focal intensity of heat within the skin, such as occurs in tropical climates or during febrile episodes. Miliaria crystallina develops due to a transient poral closure of the sweat duct opening, resulting in obstruction of free flow of eccrine sweat and retention in a vesicle below the skin surface. Dual cholinergic and adrenergic sweat gland innervation is influenced by a variety of medications used in intensive care patients. We present two febrile intensive care patients in whom enhanced alpha-adrenergic stimulation of sweat gland myoepithelia may have led to miliaria crystallina.


Assuntos
Cuidados Críticos/métodos , Erupção por Droga/etiologia , Miliária/terapia , Agonistas alfa-Adrenérgicos/efeitos adversos , Agonistas Adrenérgicos beta/efeitos adversos , Adulto , Albuterol/efeitos adversos , Clonidina/efeitos adversos , Feminino , Humanos , Masculino , Miliária/induzido quimicamente
19.
Hum Reprod ; 19(2): 430-4, 2004 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-14747192

RESUMO

BACKGROUND: Previous studies suggest that elevated basal FSH concentrations are related to aneuploid pregnancies. However, there have been no prospective studies evaluating the incidence of aneuploidies in relation to basal FSH concentrations. Since the majority of aneuploid conceptions end in early pregnancy loss or abortion of a recognized pregnancy, these determinants are appropriate intermediate end-points to study aneuploidy. METHODS: We performed a prospective study in 129 women without a history of subfertility pursuing a spontaneous pregnancy. Basal FSH concentrations were measured during three menstrual cycles. Urinary HCG levels were measured during menstruation for a maximum of six menstrual cycles, to detect early pregnancy loss. We estimated the effect of basal FSH concentrations on pregnancy outcome, taking into account possible confounders. RESULTS: We observed no significant effect of basal FSH concentrations on the incidence of early pregnancy loss or abortion of clinically recognized pregnancies. CONCLUSIONS: We conclude that in a population of women without a history of subfertility, pursuing a spontaneous pregnancy, basal FSH concentrations are not related to the incidence of early pregnancy loss or abortions. This prospective study therefore fails to confirm a relationship between signs of decreased ovarian reserve and aneuploid pregnancies.


Assuntos
Envelhecimento , Biomarcadores/sangue , Hormônio Foliculoestimulante/sangue , Ovário/fisiologia , Resultado da Gravidez , Aborto Espontâneo/sangue , Adulto , Aneuploidia , Gonadotropina Coriônica/urina , Feminino , Humanos , Ciclo Menstrual , Gravidez , Estudos Prospectivos
20.
Acta Clin Belg ; 57 Suppl 1: 16-23, 2002.
Artigo em Francês | MEDLINE | ID: mdl-11974437

RESUMO

A method of analysis was developed to determine free and glucuronated monobutyl phthalate (BuP) and monobenzyl phthalate (BeP) in urine for the assessment of exposure of man to butylbenzyl phthalate (BBP) in the workplace and in the environment. This method has also been applied in pharmacokinetic studies in experimental animals and the determination in urine of exposed workers. Urine samples are first subjected to enzymatic hydrolysis with beta-glucuronidase to enable the measurement of the total amount of monophthalates excreted. A fraction of the hydrolysate is used for further analysis. Monohexyl phthalate is added as an internal standard and the hydrolysed urine extracted with a n-hexane/dichloromethane mixture after acidification and saturation with salt. The organic fractions are washed, dehydrated and evaporated. The residue is methylated by means of diazomethane dissolved in diethylether, evaporated and further purified by extraction into n-hexane from an alkaline buffer. The organic fractions are evaporated and the residue redissolved in acetonitrile for analysis by ion trap GC-MS equipped with a 50 m apolar WCOT capillary column. TIC mass chromatograms are recorded from which SIM chromatograms can be derived electronically. The m/z values used are 91, 149, and 163 which provide a sufficient sensitive response and which are specific enough to pick up the methylated monophthalates under investigation. The quantitative limit of detection (LOQ) is 60 micrograms/L for BuP and BeP when using the Magnum ion Trap detector and 3 micrograms/L when using the Polaris Q in the splitless mode. The calibration curve in urine is linear from 120 micrograms/L to 50,000 micrograms/L with a coefficient of variation of less than 10%. In case of the Polaris Q linearity started from 10 micrograms/L. The recovery of the method is monitored by the response signal of the internal standard in the ion chromatogram. In the event of insufficient recovery the analysis is repeated. Variations in recovery are compensated by the internal standard of which the molecular structure is very similar to the ones of the monophthalates under investigation.


Assuntos
Exposição Ocupacional , Ácidos Ftálicos/farmacocinética , Teratogênios/farmacocinética , Animais , Ésteres , Cromatografia Gasosa-Espectrometria de Massas , Humanos , Ácidos Ftálicos/metabolismo , Ratos , Sensibilidade e Especificidade , Teratogênios/metabolismo
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