Cortisol secretion in patients with type 2 diabetes: relationship with chronic complications.

Objective: The presence of an enhanced cortisol secretion in patients with type 2 diabetes is debated. In type 2 diabetic subjects, cortisol secretion was found to be associated with the complications and metabolic control of diabetes. We evaluated cortisol secretion in 170 type 2 diabetic subjects and in 71 sex-, age-, and BMI-matched nondiabetic subjects.

Reduced levels of adiponectin in sleep apnea syndrome.

Background: To investigate adiponectin levels in an obese population with and without obstructive sleep apnea syndrome (OSAS) and the acute modifications in adiponectin after a whole-night control by auto continuous positive air pressure (CPAP).

Methods: 46 obese subjects [22 males, 24 females, age 55.1+/-11.

Factors associated with cesarean sections in a public hospital in Rio de Janeiro, Brazil.

Brazil has one of the world's highest cesarean section rates. Contributing factors include the organization of obstetric practice, physicians' attitudes, and women's preferences and decisions. This study aimed to identify factors associated with cesarean sections in a public maternity hospital in Rio de Janeiro.

[Mininvasive treatment of strangulated paraesophageal hiatal hernia in emergency. Case report].

The Authors report a case of strangulated paraesophageal hiatal hernia occurred in a elderly woman and treated with laparoscopic approach. After review of the literature regard on this uncommon pathology that present about 5% of the hiatal hernias, they emphasize that the laparoscopic approach is appropriated even in emergency and comprises complete reduction of the stomach in abdomen, control of suitable position of the distal esophagus and cardias and making of effective hiatus-plasty.

Comparison between six-year therapy with long-acting somatostatin analogs and successful surgery in acromegaly: effects on cardiovascular risk factors.

Context: The effects of chronic therapy with long-acting somatostatin analogs (SSTa) on metabolic and cardiovascular parameters have been partially elucidated in acromegalic patients.

Objective: The objective of this study was to compare the long-term effects of SSTa treatment and successful surgery on GH/IGF-I secretion and cardiovascular risk parameters in acromegaly. DESIGN, PATIENTS, AND INTERVENTION: This was a retrospective study of 36 acromegalic patients treated with SSTa and evaluated after a median of 66 months and of 33 sex-, age-, and body mass index-matched cured patients evaluated after a similar period of remission, all from the Institute of Endocrine Sciences (Milan, Italy).

[Quality of birth care in maternity hospitals of Rio de Janeiro, Brazil].

Objective: To evaluate the quality of birth care based on the World Health Organization guidelines.

Methods: A case-control study was carried out in a public and a private maternity hospitals contracted by the Brazilian Health System in the city of Rio de Janeiro, Brazil, from October 1998 to March 1999. The sample comprised 461 women in the public maternity hospital (230 vaginal deliveries and 231 Cesarean sections) and 448 women in the private one (224 vaginal deliveries and 224 Cesarean sections).

Similarity between neonatal profile and socioeconomic index: a spatial approach.

This study aims to compare neonatal characteristics and socioeconomic conditions in Rio de Janeiro city neighborhoods in order to identify priority areas for intervention. The study design was ecological. Two databases were used: the Brazilian Population Census and the Live Birth Information System, aggregated by neighborhoods.

[A fecal fistula in patient who underwent an abdomino-perineal resection with a continent magnetic prosthesis: observations on an obsolete technique].

The Authors consider a case of a patient who underwent an abdominal-perineal resection and presented a fecal fistula as a late complication of a magnetic prosthesis implant. After a revision of the literature, the Authors evaluate the reasons for abandoning this surgical technique of continence many years ago, underlying not only the complications observed during the experimentation but also the lack of those benefits for which this technique was proposed.

Long-term monitoring of insulin sensitivity in growth hormone-deficient adults on substitutive recombinant human growth hormone therapy.

Since the effects of recombinant human growth hormone (rhGH) replacement therapy on glucose metabolism are still a matter of debate, the aim of the present study was to evaluate the impact of long-term rhGH treatment on insulin sensitivity. Simple indices of insulin resistance (IR) and insulin sensitivity (IS), based on fasting glucose and insulin, such as the homeostasis model assessment of insulin resistance (HOMA-IR) and the quantitative insulin check index (QUICKI), were used to estimate the degree of IR and IS in 20 normoglycemic patients (11 men and 9 women; mean age, 44 +/- 14 years) with severe adult-onset GH deficiency (GHD). Measurements were determined at baseline and after 1 and 5 years of continuous rhGH therapy.

[Cesarean sections: who wants them and under what circumstances?].

Brazil has extremely high cesarean rates. Among related factors, it has been suggested that a "culture of cesarean childbirth" (or a preference for this type of delivery) exists among Brazilian women. Our study investigates this notion.

[Cooperation and conflict in childbirth care: representations and practices of nurses and obstetricians].

In Brazil, where birthing generally occurs in hospitals and under the care of obstetricians, the incorporation of nurses is a strategy that has been used recently in an attempt to improve obstetric care. This study, conducted in two maternity hospitals in Rio de Janeiro, focuses on representations of obstetricians and nurses regarding teamwork and analyzes how the dimensions of power, cooperation/conflict, and technical autonomy are permeated by dualistic conceptions which influence the quality of health care for women during childbirth. On the one hand, the results show a consensus regarding the advantages of professional cooperation in the improvement of health care, assuming the existence of a clear definition of professional roles.

Growth hormone therapy in GH-deficient adults: continuous vs alternate-days treatment.

In the present report, we have compared 12 months of rhGH therapy given daily (D) at the beginning and then on alternate days (A) to 20 subjects with severe adult-onset GH deficiency (GHD). Aim of the study was to establish whether the lower frequency injection regimen is as effective as the daily dose. Measurements included: IGF-I levels, body composition (BF%), lipid profile, insulin sensitivity by homeostasis model assessment (HOMA-IR) and quantitative insulin check index (QUICKI), as well as thyroid function.

Evaluation of insulin resistance in acromegalic patients before and after treatment with somatostatin analogues.

Many studies have recently shown that simple computer-solved indices, based on fasting glucose and insulin levels, closely mirror the euglycemic clamp technique in studying insulin resistance or pancreatic insulin secretion. Few data are at present available on the evaluation of these novel indices in acromegalic patients, known to be GH-dependent insulin-resistant subjects, in particular during medical treatment with somatostatin analogues. Indeed, these drugs are able to inhibit not only GH and IGF-I levels, but also insulin and glucagon pancreatic secretion, with contrasting effects on glucose metabolism.

Factors associated with vaginal birth after cesarean in a maternity hospital of Rio de Janeiro.

Objectives: Identifying characteristics associated with vaginal birth after cesarean.

Study Design: Case-control study based on medical records.

Study Population: women with previous cesarean, who had delivered in a public Rio de Janeiro maternity hospital between 1992 and 1996.

Differential trends in mortality from AIDS in men and women in Brazil (1984-1995).

Objective: To analyse trends in AIDS mortality in men and women in Brazil, for the period 1984-1995.

Design And Methods: National statistics on yearly numbers of reported deaths by cause, in conjunction with census population counts and inter-censory estimates, were used to calculate age- and sex-specific AIDS mortality rates for Brazil as a whole and for São Paulo and Rio de Janeiro, the two largest cities in Brazil, and those most affected by the AIDS epidemic to date.

Results: Numbers of reported deaths from AIDS have increased yearly in Brazil since 1984, to approximately 15,000 in 1995.

[Gastric leiomyoma. Diagnostic and surgical problems].

The Authors report their three year experience with five patients suffering from gastric leiomyoma, each with different anatomical and clinical characteristics. The Authors have performed a research of the different diagnostics, clinical and therapeutic problems of these rare tumors that sometimes are asymptomatic in spite of the large size they reach, but more frequently they present with haemorrhagic symptoms which tend to point to other more frequent pathological conditions. Diagnosis can only be suspected, but cannot be reached without a histological examination, also if the classifications of these tumors have been argument of many changes, particularly by the light of the recent diagnostics possibilities offered by ultrastructural and immunohistochemical examination.

The role of high resolution pulsed and color Doppler ultrasound in the differential diagnosis of benign and malignant lymphadenopathy: results of multivariate analysis.

Background: The role of high resolution pulsed and color Doppler ultrasound in the differential diagnosis of benign and malignant lymphadenopathy is still unclear.

Methods: High resolution pulsed and color Doppler ultrasound was used prospectively to investigate superficial lymph node enlargement in 71 patients undergoing surgical biopsy at the onset of lymphadenopathy. The aim of this study was to define, in multivariate analysis, the ultrasonographic parameters useful in the differential diagnosis of benign and malignant lymphadenopathy.

[Birth profile for the city of rio de janeiro: a spatial analysis].

This article analyzes the birth profile by neighborhood in the city of Rio de Janeiro, using data for 1994 from the Data Base on Live Births. Pattern maps were employed in addition to the Moran I statistical test to detect spatial clustering. Proportions of live newborns with an Apgar score of 8-10, cesareans, mothers with greater than a secondary school education, and teenage mothers displayed visually identifiable spatial patterns and significant spatial self-correlation.

[Cervical neurinomas. (Considerations in five cases operated in Day-Surgery)].

We report the experiment of five cases of neurinoma observed in the division of Day Surgery of the Third Surgery Clinic, operating in the Hematology Institute of University of Studies "La Sapienza" in Rome. The problems of the diagnosis of this neoplasia has been faced, though it is commonly unknown or confused with other cervical especially lymphonodules tumefactions, from which it is almost impossible to distinguish before the operation. In the period of six years on 775 cases of cervical neoformations have been operated only 5 patients bearers of neuromi; two originated from vago cervicale (right and left), one from simpatico cervicale on the left, another from the left spinal accessory and the last from the secondary medial trunk of the left brachial plexus.

[Surgery in hemopathies: experience in ambulatory care and day surgery].

The one day surgery experience of our team developed in many years of a Special Surgical Service in Haematologic Diseases (within the III Surgical Department directed by Prof. G. Di Matteo of the University of Rome "La Sapienza") is herein reported.

[Dysplasia epiphysealis hemimelica].

The Authors present 9 patients affected by Dysplasia Epiphysealis Hemimelica with a mean follow-up of 11 years (range 5 years-21 years). The Authors confirm the benignity of the disease and report the variability of the clinical evolution of this rare type of osteochondrodysplasia. Besides cases with spontaneous evolution characterized by no clinical evidence of the disease, there are cases that require surgical removal of the osteochondromas and, sometimes, corrective interventions because of axial deviations and/or limb discrepancy.

[A survey of demand for medical care in three public health clinics in Rio de Janeiro, Brazil].

A sample survey was conducted in three public ambulatory medical care units in Rio de Janeiro in order to show the demographic and nosological aspects of the clientele as well as to evaluate the quality of clinic records. The sample included 2,029 patients registered in the health clinics and 3,980 consultants from October 1, 1990 to September 30, 1991. The diagnoses were coded according to the 9th revision of the International Classification of Dieases.

[Ultrasonography in the diagnosis and follow-up of hip pain in children].

Fifty-seven subjects aged 1.5-14 years (mean: 6.5; standard deviation: 3.