bluuebunny/crossref_metadata_2025 huggingface dataset:
The course of the inferior gluteal nerve in the posterior approach to the hip
Authors: Ling Z. X. , Kumar V. P.
Published: December 2006

We investigated the relationship of the inferior gluteal nerve to gluteus maximus by dissecting the muscle in 12 fresh-frozen and formalin-treated cadavers. The anatomy was recorded using still digital photography. The course of the inferior gluteal nerve was carefully traced and was noted to enter the deep surface of gluteus maximus approximately 5 cm from the tip of the greater trochanter of the femur. The susceptibility of the nerve to injury during a posterior approach to the hip may be explained by its close relationship to the deep surface of gluteus maximus. It is easily damaged before it has been seen if the muscle is split and parted more than 5 cm from the tip of the greater trochanter of the femur. We suggest that a modified posterior approach be used to expose the hip to avoid damage to this nerve.
The Exeter Universal stem
Authors: Hook S. , Moulder E. , Yates P. J. , Burston B. J. , Whitley E. , Bannister G. C.
Published: December 2006

We reviewed 142 consecutive primary total hip replacements implanted into 123 patients between 1988 and 1993 using the Exeter Universal femoral stem. A total of 74 patients (88 hips) had survived for ten years or more and were reviewed at a mean of 12.7 years (10 to 17). There was no loss to follow-up.

The rate of revision of the femoral component for aseptic loosening and osteolysis was 1.1% (1 stem), that for revision for any cause was 2.2% (2 stems), and for re-operation for any cause was 21.6% (19 hips). Re-operation was because of failure of the acetabular component in all but two hips.

All but one femoral component subsided within the cement mantle to a mean of 1.52 mm (0 to 8.3) at the final follow-up. One further stem had subsided excessively (8 mm) and had lucent lines at the cement-stem and cement-bone interfaces. This was classified as a radiological failure and is awaiting revision. One stem was revised for deep infection and one for excessive peri-articular osteolysis. Defects of the cement mantle (Barrack grade C and D) were found in 28% of stems (25 hips), associated with increased subsidence (p = 0.01), but were not associated with endosteal lysis or failure.

Peri-articular osteolysis was significantly related to the degree of polyethylene wear (p < 0.001), which was in turn associated with a younger age (p = 0.01) and male gender (p < 0.001).

The use of the Exeter metal-backed acetabular component was a notable failure with 12 of 32 hips (37.5%) revised for loosening. The Harris-Galante components failed with excessive wear, osteolysis and dislocation with 15% revised (5 of 33 hips). Only one of 23 hips with a cemented Elite component (4%) was revised for loosening and osteolysis.

Our findings show that the Exeter Universal stem implanted outside the originating centre has excellent medium-term results.
Fentanyl HCl Patient-Controlled lontophoretic Transdermal System for the Management of Acute Postoperative Pain
Authors: Mayes Stacey , Ferrone Marcus
Published: December 2006

Objective:

To summarize the pharmaceutics, pharmacokinetics, development, and clinical application of IONSYS, the fentanyl HCl patient-controlled iontophoretic transdermal system for the management of acute postoperative pain.

Data Sources:

Clinical literature including both primary sources and review articles was accessed through a search of the MEDLINE databases (1980–October 2006). Key search terms included cutaneous analgesia, fentanyl, IONSYS, opioid, postoperative pain, and patient-controlled analgesia (PCA). Additional clinical trial and drug data were supplied by the manufacturer, the ALZA Corporation.

Study Selection and Data Extraction:

Review articles, abstracts, and clinical studies related to patient-controlled iontophoretic transdermal fentanyl and postoperative pain management were analyzed. An evaluation of the research exploring IONSYS for the management of acute postoperative pain was conducted. Relevant information was then selected and is provided in this article.

Data Synthesis:

IONSYS is the first iontophoretic transdermal drug delivery system that utilizes low-level electrical energy to actively transport ionized fentanyl HCl through intact skin. Research has revealed that use of IONSYS for patients with acute postoperative pain is safe, effective, and well tolerated. Phase I–III trials have demonstrated an appropriate dosing range leading to effective analgesia, with minimal adverse effects. The analgesia provided by this system was found to be superior to that of analgesia placebo and equivalent to that of an intravenous morphine PCA.

Conclusions:

Data from clinical trials indicated that IONSYS is successful in controlling acute postoperative pain that circumvents the limitations of intravenous patient-controlled analgesia. The use of this system may serve as an alternative modality for the management of acute pain without increasing such adverse effects as bleeding, intravenous catheter infiltration, or manual pump malfunction.
Doing good, doing harm, being well and burning out: The interactions of perceived prosocial and antisocial impact in service work
Authors: Grant Adam M. , Campbell Elizabeth M.
Published: December 2006

Service employees often perceive their actions as harming and benefiting others, and these perceptions have significant consequences for their own well‐being. We conducted two studies to test the hypothesis that perceptions of benefiting others attenuate the detrimental effects of perceptions of harming others on the well‐being of service employees. In Study 1, a survey of 377 transportation service employees and 99 secretaries, perceived prosocial impact moderated the negative association between perceived antisocial impact and job satisfaction, such that the association decreased as perceived prosocial impact increased. In Study 2, a survey of 79 school teachers, perceived prosocial impact moderated the association between perceived antisocial impact and burnout, and this moderated relationship was mediated by moral justification; the results held after controlling for common antecedents of burnout. The results suggest that perceptions of benefiting others may protect service employees against the decreased job satisfaction and increased burnout typically associated with perceptions of harming others. Implications for research on burnout, job satisfaction, positive organizational scholarship and job design are discussed.
Use of Serologic Markers as a Screening Tool in Inflammatory Bowel Disease Compared With Elevated Erythrocyte Sedimentation Rate and Anemia
Authors: Sabery Nasim , Bass Dorsey
Published: December 2006

OBJECTIVES. The purpose of this work was to evaluate the use of serologic testing as a screening test for inflammatory bowel disease compared with erythrocyte sedimentation rate and hemoglobin in a referred patient population with suspected inflammatory bowel disease.

PATIENTS AND METHODS. A retrospective study was performed, reviewing medical charts of patients who had inflammatory bowel disease serology performed at Prometheus Laboratories from September 2002 to September 2004. Patients were divided into 4 categories: ulcerative colitis, Crohn disease, indeterminate colitis, and noninflammatory bowel disease groups. Patients were categorized based on clinical evaluation by board-certified pediatric gastroenterologists.

RESULTS. A total of 227 patients seen at the Lucile Packard Children's Hospital Gastroenterology Clinic had inflammatory bowel disease serology performed at or before the time of diagnosis. Seventeen charts were excluded secondary to inadequate information. Forty children were found to have inflammatory bowel disease, a prevalence of 19%. Overall, serologic testing for inflammatory bowel disease had 60% sensitivity and 92% specificity. A positive laboratory test for anemia or an elevated erythrocyte sedimentation rate had 83% sensitivity, whereas the combination of anemia and elevated erythrocyte sedimentation rate had 96% specificity. The positive predictive value of serologic testing was 60% compared with 79% in patients with anemia and elevated erythrocyte sedimentation rate. The positive predictive value of serologic testing in the subgroup of subjects without rectal bleeding (139 subjects) was only 35% compared with 60% using routine tests. Almost one third of all positive serologic tests were in patients with no demonstrable inflammatory bowel disease.

CONCLUSIONS. As a pediatric inflammatory bowel disease screening strategy for the general pediatrician or gastroenterologist, the measurement of the combination of erythrocyte sedimentation rate and hemoglobin has a higher positive predictive value and is more sensitive, more specific, and less costly than commercial serologic testing.
Marcinkiewicz strong laws for linear statistics of rho*-mixing sequences of random variables
Authors: Cai Guang-Hui
Published: December 2006

Strong laws are established for linear statistics that are weighted sums of a random sample. We show extensions of the Marcinkiewicz-Zygmund strong laws under certain moment conditions on both the weights and the distribution. These not only generalize the result of Bai and Cheng (2000, Statist Probab Lett 46: 105-112) to rho*-mixing sequences of random variables, but also improve them.
Essential oil from two populations of Echinodorus grandiflorus (Cham. & Schltdl.) Micheli (Chapéu de couro)
Authors: Pimenta Daniel S. , Figueiredo Maria Raquel , Kaplan Maria Auxiliadora C.
Published: December 2006

Analysis by Gas Chromatography and Gas Chromatography/Mass Spectrometry of the essential oils obtained from leaves of Echinodorus grandiflorus ("Chapéu de couro") from two different populations (Big Leaves and Small Leaves), collected monthly between September 1998 and December 1999 revealed 17 components. Phytol was the major constituent for both populations. The main sesquiterpene representatives are (E)-caryophyllene, alpha-humulene and (E)-nerolidol.
Efficiency of playback for assessing the occurrence of five bird species in Brazilian Atlantic Forest fragments
Authors: Boscolo Danilo , Metzger Jean Paul , Vielliard Jacques M.E.
Published: December 2006

Playback of bird songs is a useful technique for species detection; however, this method is usually not standardized. We tested playback efficiency for five Atlantic Forest birds (White-browed Warbler Basileuterus leucoblepharus, Giant Antshrike Batara cinerea, Swallow-tailed Manakin Chiroxiphia caudata, Whiteshouldered Fire-eye Pyriglena leucoptera and Surucua Trogon Trogon surrucura) for different time of the day, season of the year and species abundance at the Morro Grande Forest Reserve (South-eastern Brazil) and at thirteen forest fragments in a nearby landscape. Vocalizations were broadcasted monthly at sunrise, noon and sunset, during one year. For B. leucoblepharus, C. caudata and T. surrucura, sunrise and noon were more efficient than sunset. Batara cinerea presented higher efficiency from July to October. Playback expanded the favourable period for avifaunal surveys in tropical forest, usually restricted to early morning in the breeding season. The playback was efficient in detecting the presence of all species when the abundance was not too low. But only B. leucoblepharus and T. surrucura showed abundance values significantly related to this efficiency. The present study provided a precise indication of the best daily and seasonal periods and a confidence interval to maximize the efficiency of playback to detect the occurrence of these forest species.
Immunology and immunopathology of African trypanosomiasis
Authors: Vincendeau Philippe , Bouteille Bernard
Published: December 2006

Major modifications of immune system have been observed in African trypanosomiasis. These immune reactions do not lead to protection and are also involved in immunopathology disorders. The major surface component (variable surface glycoprotein,VSG) is associated with escape to immune reactions, cytokine network dysfunctions and autoantibody production. Most of our knowledge result from experimental trypanosomiasis. Innate resistance elements have been characterised. In infected mice, VSG preferentially stimulates a Th 1-cell subset. A response of gd and CD8 T cells to trypanosome antigens was observed in trypanotolerant cattle. An increase in CD5 B cells, responsible for most serum IgM and production of autoantibodies has been noted in infected cattle. Macrophages play important roles in trypanosomiasis, in synergy with antibodies (phagocytosis) and by secreting various molecules (radicals, cytokines, prostaglandins,...). Trypanosomes are highly sensitive to TNF-alpha, reactive oxygen and nitrogen intermediates. TNF-alpha is also involved in cachexia. IFN-gamma acts as a parasite growth factor. These various elements contribute to immunosuppression. Trypanosomes have learnt to use immune mechanisms to its own profit. Recent data show the importance of alternative macrophage activation, including arginase induction. L-ornithine produced by host arginase is essential to parasite growth. All these data reflect the deep insight into the immune system realised by trypanosomes and might suggest interference therapeutic approaches.
GMOs: building the future on the basis of past experience
Authors: Reis Luiz F.L. , Van Sluys Marie-Anne , Garratt Richard C. , Pereira Humberto M. , Teixeira Mauro M.
Published: December 2006

Biosafety of genetically modified organisms (GMOs) and their derivatives is still a major topic in the agenda of government and societies worldwide. The aim of this review is to bring into light that data that supported the decision taken back in 1998 as an exercise to stimulate criticism from the scientific community for upcoming discussions and to avoid emotional and senseless arguments that could jeopardize future development in the field. It must be emphasized that Roundup Ready® soybean is just one example of how biotechnology can bring in significant advances for society, not only through increased productivity, but also with beneficial environmental impact, thereby allowing more rational use of agricultural pesticides for improvement of the soil conditions. The adoption of agricultural practices with higher yield will also allow better distribution of income among small farmers. New species of genetically modified plants will soon be available and society should be capable of making decisions in an objective and well-informed manner, through collegiate bodies that are qualified in all aspects of biosafety and environmental impact.
The ubiquitous gp63-like metalloprotease from lower trypanosomatids: in the search for a function
Authors: Santos André L.S. , Branquinha Marta H. , D'Avila-Levy Claudia M.
Published: December 2006

Plant and insect trypanosomatids constitute the "lower trypanosomatids", which have been used routinely as laboratory models for biochemical and molecular studies because they are easily cultured under axenic conditions, and they contain homologues of virulence factors from the classic human trypanosomatid pathogens. Among the molecular factors that contribute to Leishmania spp. virulence and pathogenesis, the major surface protease, alternatively called MSP, PSP, leishmanolysin, EC 3.4.24.36 and gp63, is the most abundant surface protein of Leishmania promastigotes. A myriad of functions have been described for the gp63 from Leishmania spp. when the metacyclic promastigote is inside the mammalian host. However, less is known about the functions performed by this molecule in the invertebrate vector. Intriguingly, gp63 is predominantly expressed in the insect stage of Leishmania, and in all insect and plant trypanosomatids examined so far. The gp63 homologues found in lower trypanosomatids seem to play essential roles in the nutrition as well as in the interaction with the insect epithelial cells. Since excellent reviews were produced in the last decade regarding the roles played by proteases in the vertebrate hosts, we focused in the recent developments in our understanding of the biochemistry and cell biology of gp63-like proteins in lower trypanosomatids.
Sustainable farming with native rocks: the transition without revolution
Authors: Fyfe William S. , Leonardos Othon H. , Theodoro Suzi H.
Published: December 2006

The development process which humanity passed through favored a series of conquests, reflected in the better quality of life and longevity, however, it also provoked upsets and severe transformation in the environment and in the human food security. Such process is driving the ecosystems to be homogeneous, and, therefore, the nutrients' supply, via nourishment. To change this panorama, the present work discusses the gains of incorporating the stonemeal technique as a strategic alternative to give back the essential fertile characteristics to the soils. This technology has the function of facilitating the rejuvenation of the soils and increasing the availability of the necessary nutrients to the full development of the plants which is a basic input for the proliferation of life in all its dimensions.
The Trofobiose Theory and organic agriculture: the active mobilization of nutrients and the use of rock powder as a tool for sustainability
Authors: Polito Wagner L.
Published: December 2006

The primary objective of the present paper is to link some relevant concepts on the use of ecological agricultural practices to the production of food crops. In a special topic the Trofobiose Theory, as well as the principle of Active Dissolution of Rocks are considered as important tools in improving the sustainability of Organic, Biodynamic and Process Agricultures.
Potential of East African phosphate rock deposits in integrated nutrient management strategies
Authors: Jama Bashir , Van Straaten Peter
Published: December 2006

Phosphorus deficiency affects around 80% of the acid soils of western Kenya, but fertilizer use is limited due to high prices. This paper explores the potential of local phosphate rocks (PR) as a remedy within the context on an integrated soil fertility management approach. A promising phosphate rock is Minjingu PR (MPR, Tanzania), a sedimentary/biogenic deposit which contains about 13% total P and 3% neutral ammonium citrate (NAC) soluble P. On-farm trials in P-deficient soils in western Kenya demonstrate MPR to be as effective as triple superphosphate (TSP, 20% P) at equal P rates. The benefits are most pronounced with the integration of agroforestry technologies that improve soil fertility. Besides Minjingu PR, Busumbu PR from Uganda (BPR) is potentially another source of P. It is typical of the abundant but unreactive igneous PRs in eastern, central and southern Africa. Agronomic performance of BPR is poorer, though its lower cost and location near to P-deficient areas in western Kenya make it attractive in some situations. The policy implications of these findings are discussed further in the paper.
Plant- and microbial-based mechanisms to improve the agronomic effectiveness of phosphate rock: a review
Authors: Arcand Melissa M. , Schneider Kim D.
Published: December 2006

Deficiency in plant-available phosphorus is considered to be a major limiting factor to food production in many agricultural soils. Mineral resources are necessary to restore soil phosphorus content. In regions where conventional fertilizers are not used due to cost limitations or to mitigate adverse environmental effects, local sources of phosphate rock are being increasingly recognized for potential use as alternative phosphorus fertilizers. The main obstacle associated with using directly applied ground phosphate rock is that the phosphate released is often unable to supply sufficient plant-available phosphorus for crop uptake. Plantand microbial-based mechanisms are low-cost, appropriate technologies to enhance the solubilization and increase the agronomic effectiveness of phosphate rock. Common mechanisms of phosphate rock dissolution including proton and organic acid production will be reviewed for both plants and microorganisms. This review will also address possibilities for future research directions and applications to agriculture, as well as highlight ongoing research at the University of Guelph, Guelph, Canada.
Articles with authors affiliated to Brazilian institutions published from 1994 to 2003 with 100 or more citations: I - the weight of international collaboration and the role of the networks
Authors: Packer Abel L. , Meneghini Rogerio
Published: December 2006

Articles with 100 citations or more in the scientific literature and with at least one author with Brazilian affiliation, were identified in the Thomson-ISI (Institute for Scientific Information) Web of Science bibliometric database, covering a 10-year period, from 1994 to 2003; 248 (0.23%) out of a total of 109,916 articles with Brazilian affiliation were identified. This study was primarily carried out to identify thematic nuclei of excellence in research that had major impact in the international literature (Meneghini and Packer 2006). The regional and institutional affiliation distributions of these articles follow approximately that of the total of Brazilian articles in the ISI database. However, some significant deviations are observed derived from the outstanding performance of a few groups responsible for the publication of the HC-ISI (Highly cited ISI) papers. The international collaboration and the network organization of work played a fundamental role in these results. It is evident that the role played by organizations in research networks as well as the international collaborations exerted strong influence in the impact of these articles, although with distinct amplitude in the different fields.
Bone quality: what is it and how is it measured?
Authors: Compston Juliet
Published: December 2006

Bone quality describes aspects of bone composition and structure that contribute to bone strength independently of bone mineral density. These include bone turnover, microarchitecture, mineralisation, microdamage and the composition of bone matrix and mineral. New techniques to assess these components of bone quality are being developed and should produce important insights into determinants of fracture risk in untreated and treated disease.
Peripheral bone densitometry: clinical applications
Authors: Eis Sergio Ragi , Lewiecki E. Michael
Published: December 2006

Technologies for the measurement of bone mineral density and other parameters of bone strength at peripheral skeletal sites have been studied since the 1960s. Single-energy Photon Absorptiometry (SPA), Radiographic Absorptiometry (RA), Radiogrametry (RG), Single-energy X-ray Absorptiometry (SXA), Peripheral Dual-energy X-ray Absorptiometry (pDXA), and Quantitative Ultrasonometry (QUS) have been successively evaluated. These technologies and their clinical applications are discussed in this article. The available scientific evidence supports the clinical use of these technologies at peripheral skeletal for assessment of fracture risk. Peripheral measurements other than the 33% (one-third) radius by DXA cannot be used to diagnose osteoporosis according to current standards. Peripheral skeletal sites are not clinically useful for monitoring changes in BMD with natural evolution of the disease and its treatment. Peripheral BMD measurement can theoretically be used to screen patients for selection to central DXA testing, although device-specific cut-points should be developed before this is implemented. When central DXA testing is not available, peripheral BMD testing may be considered to identify individuals who might benefit from pharmacological intervention.
Clinical application of biochemical markers of bone turnover
Authors: Seibel Markus J.
Published: December 2006

With the ageing population in most countries, disorders of bone and mineral metabolism are becoming increasingly relevant to every day clinical practice. Consequently, the interest in, and the need for effective measures to be used in the screening, diagnosis and follow-up of such pathologies have markedly grown. Together with clinical and imaging techniques, biochemical tests play an important role in the assessment and differential diagnosis of metabolic bone disease. In recent years, the isolation and characterisation of cellular and extracellular components of the skeletal matrix have resulted in the development of molecular markers that are considered to reflect either bone formation or bone resorption. These biochemical indices are non-invasive, comparatively inexpensive and, when applied and interpreted correctly, helpful tools in the diagnostic and therapeutic assessment of metabolic bone disease. This review provides an overview of the current evidence regarding the clinical use of biochemical markers of bone remodelling in bone disease, with an emphasis on osteoporosis.
Evolution of PTH assays
Authors: Vieira José Gilberto H. , Kunii Ilda , Nishida Sônia
Published: December 2006

PTH metabolism is complex and the circulating forms include the intact 1-84 molecule as well as several carboxyl-terminal fragments. The first generation of PTH assays included several types of competitive assays, with specificities that spanned carboxyl, mid-region and amino-terminal portions of the molecule. The limitations of these assays and the methodological evolution led to the description of 2nd generation non-competitive immunometric assays for PTH in the late 80's, based on the recognition of the PTH molecule by two different antibodies, one directed against de amino-terminal and other against the carboxyl-terminal segments. The observation that in some circumstances "long" carboxyl-terminal segments were also measured by 2nd generation assays led to the development of 3rd generation assays based on amino-terminal specific antibodies that are specific for the first amino acids, measuring only the molecular forms that activate PTH1R. The practical and cost-benefit advantages of these assays are still debatable. The recent observation that carboxyl-terminal fragments of PTH have biological activity via a distinct receptor than PTH1R, points to the future need of more than one assay in order to evaluate parathyroid hormone function.
Asymptomatic primary hyperparathyroidism
Authors: Bilezikian John P. , Rubin Mishaela , Silverberg Shonni J.
Published: December 2006

Primary hyperparathyroidism is a common disorder of mineral metabolism characterized by incompletely regulated, excessive secretion of parathyroid hormone from one or more of the parathyroid glands. In adults with the disease, a single, benign adenoma is seen approximately 80 percent of the time, with multiple gland involvement comprising most of the remaining patients. Very rarely, a parathyroid cancer is responsible but it is seen in less than 0.5 percent of patients with primary hyperparathyroidism. In this article, we will review important clinical and diagnostic features of asymptomatic primary hyperparathyroidism as well as considerations for surgical or medical management of the disease.
Calcium intake and disease prevention
Authors: Heaney Robert P.
Published: December 2006

While the fundamental metabolic function of calcium is to serve as a second messenger, coupling intracellular responses to extracellular signals, nutritional deficiency of calcium is manifested at a higher level of organization: 1) depletion of the calcium nutrient reserve; 2) inadequate complexation of digestive byproducts; and 3) collateral effects of hormones produced primarily to compensate for low calcium intake. The first mechanism contributes to the osteoporosis problem, the second to kidney stones and colon cancer, and the third to hypertension, preeclampsia, obesity, and insulin resistance, among others. Adequate calcium intakes (10001500 mg/d) in adults have been shown in controlled trials to lower the risk of osteoporotic fractures, kidney stones, obesity, and hypertension. The best source of calcium is dairy foods, largely because the disorders concerned depend upon multiple nutrients, not just calcium, and dairy provides a broad array of essential nutrients in addition to calcium, and at low cost.
Selective estrogen receptor modulators (SERMS)
Authors: Diez-Perez Adolfo
Published: December 2006

Hormone receptors and, specifically, estrogen receptors were described about four decades ago. For estrogens, there are two receptors, estrogen receptor alpha (ERalpha) and estrogen receptor beta (ERbeta). The two receptors are coded by different genes and their tissue expression varies across organs. ERalpha is predominantly expressed in reproductive tissues (uterus, breast, ovaries) liver and central nervous system, whereas ERbeta is expressed in other tissues such as bone, endothelium, lungs, urogenital tract, ovaries, central nervous system and prostate. More than seventy molecules that belong to the SERMS class have been described. There are 5 chemical groups: triphenylethylenes, benzotiophenes, tetrahydronaphtylenes, indoles and benzopyrans. All of these non-hormonal compounds are capable of activating the ER, reduce bone turnover rate and, as an antiresorptive, clearly improve bone density. Estrogens reduce bone turnover rate and, as an antiresorptive, clearly improve bone density. They are also beneficial for the relief of menopausal symptoms. An ongoing debate that extends over the decades, relates to to overall benefit/risk profile of estrogen or estrogen-progestin therapy since these therapies can increase the risk of serious health disorders, such as breast cancer. SERMs have increased our understanding of hormone-receptor regulatory mechanisms. Their development has permitted a targeted efficacy profile avoiding some of the side effects of the hormone therapy. Their clinical utility relies today mostly on the effects on breast cancer and bone.
Update on osteoporosis therapy
Authors: Borges João Lindolfo C. , Bilezikian John P.
Published: December 2006

Osteoporosis is a skeletal disorder characterized by compromised bone strength that predisposes a person to increased fracture risk. Fractures are often associated with increased morbidity, higher mortality, loss of function and even psychological consequences. Pharmacotherapeutic interventions (e.g., bisphosphonates, selective estrogen receptor modulators, calcitonin, and teriparatide) in women with postmenopausal osteoporosis provide substantial reduction in fracture risk over and above risk reduction with calcium and vitamin D supplementation alone. The importance of nutritional support along with an appropriate exercise regimen, avoiding smoking and excessive alcohol use is to be emphasized along with the pharmacologic approach to osteoporosis. Despite the effectiveness of therapy with pharmacologic agents, most patients who start therapy do not remain on treatment for more than 1 year.
Osteoporosis in men
Authors: Binkley Neil
Published: December 2006

Osteoporosis is defined as "a systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue with a consequent increase in bone fragility and susceptibility to fracture". Approximately 4050% of women sustain osteoporotic fractures in their lifetime; as such, it is appropriate that studies initially focused upon females. Despite an increased recognition of osteoporotic fractures in men, there continues to be neglect of this disease in males. This ongoing neglect is inappropriate as 2533% of men in some populations will sustain osteoporotic fractures in their lifetime. Testosterone plays an important role in male skeletal health. However, recent data suggest that estrogen may in fact be the dominant hormone regulating skeletal status in both men and women. BMD measurement may be utilized for osteoporosis diagnosis and to assist with fracture risk prediction in men prior to their sustaining a fracture. Recognizing this need, the International Society for Clinical Densitometry (ISCD) recommended and recently reaffirmed use of a BMD T-score of -2.5 or below be utilized to diagnose osteoporosis in men. Androgen therapy of hypogonadal men may be considered with the caveat that data do not exist to document that this treatment reduces fracture risk. At this time, the data is inadequate to support use of androgen treatment in eugonadal men with osteoporosis. Parathyroid hormone treatment does increase BMD; existing studies have not been of adequate size or duration to document fracture reduction efficacy. Bisphosphonate therapy increases BMD, reduces vertebral fracture risk and is considered the standard of care for osteoporotic men at this point in time.
Transplantation osteoporosis
Authors: Kulak Carolina A.M. , Borba Victoria Z.C. , Kulak Júnior Jaime , Shane Elizabeth
Published: December 2006

In the past two decades, there has been a rapid increase in the number of organ transplanted worldwide, including Brazil, along with an improvement in survival and quality of life of the transplant recipients. Osteoporosis and a high incidence of fragility fractures have emerged as a complication of organ transplantation. Many factors contribute to the pathogenesis of osteoporosis following organ transplantation. In addition, most patients have some form of bone disease prior to transplantation, which is usually related to adverse effects of end-stage organ failure on the skeleton. This chapter reviews the mechanisms of bone loss that occur both in the early and late post-transplant periods, as well as the features specific to bone loss after kidney, lung, liver, cardiac and bone marrow transplantation. Prevention and treatment for osteoporosis should be instituted prior and in the early and late phase after transplantation, and will also be addressed in this article.
Hypophosphatemic rickets and osteomalacia
Authors: Menezes Filho Hamilton de , Castro Luiz Claudio G. de , Damiani Durval
Published: December 2006

The hypophosphatemic conditions that interfere in bone mineralization comprise many hereditary or acquired diseases, all of them sharing the same pathophysiologic mechanism: reduction in the phosphate reabsorption by the renal tubuli. This process leads to chronic hyperphosphaturia and hypophosphatemia, associated with inappropriately normal or low levels of calcitriol, causing osteomalacia or rickets in children and osteomalacia in adults. X-linked hypophosphatemic rickets, autosomal-dominant hypophosphatemic rickets, and tumor-induced osteomalacia are the main syndromes involved in the hypophosphatemic rickets. Although these conditions exhibit different etiologies, there is a common link among them: increased activity of a phosphaturic factor, being the fibroblast growth factor 23 (FGF-23) the most studied one and to which is attributed a central role in the pathophysiology of the hyperphosphaturic disturbances. Activating mutations of FGF-23 and inactivating mutations in the PHEX gene (a gene on the X chromosome that codes for a Zn-metaloendopeptidase proteolytic enzyme which regulates the phosphate) involved in the regulation of FGF-23 have been identified and have been implicated in the pathogenesis of these disturbances. Genetic studies tend to show that the phosphorus homeostasis depends on a complex osteo-renal metabolic axis, whose mechanisms of interaction have been poorly understood so far. This paper reviews the current knowledge status concerning the pathophysiology of phosphate metabolism regulation and the pathophysiologic basis of hypophosphatemic rickets. It also analyzes the clinical picture and the therapeutic aspects of these conditions as well.
Paget's disease of bone
Authors: Griz Luiz , Caldas Gustavo , Bandeira Cristina , Assunção Viviane , Bandeira Francisco
Published: December 2006

Paget's disease of bone is a focal disorder of bone remodeling accompanied initially by an increase in bone resorption, followed by a disorganized and excessive formation of bone, leading to pain, fractures and deformities. It exhibits a marked geographical variation in its prevalence. In Brazil it predominantly affects persons of European descent. The majority of the reported cases of the disease in Brazil are from Recife, owing to its peculiar mixed European colonization over approximately four centuries. The etiology is complex and involves both genetic and environmental factors. The disease is often asymptomatic and diagnosis is usually based on biochemical markers of bone turnover, radionuclide bone scan and radiological examination. Bisphosphonates, in particular zoledronic acid, are regarded as the treatment of choice for Paget's disease of bone.
Síndrome de Wolfram: da definição às bases moleculares
Authors: Ribeiro Maria Regina F. , Crispim Felipe , Vendramini Márcio F. , Moisés Regina S.
Published: December 2006

A síndrome de Wolfram (SW) é uma condição neurodegenerativa progressiva de herança autossômica recessiva caracterizada pela presença de diabetes mellitus e atrofia óptica. Freqüentemente também estão presentes o diabetes insipidus e disacusia neurossensorial, explicando o acrônimo DIDMOAD (diabetes insipidus, diabetes mellitus, optic atrophy, deafness) pelo qual a síndrome é também conhecida. Além desses, outros comemorativos tais como bexiga neurogênica, ataxia, nistagmo e predisposição a doenças psiquiátricas podem também estar presentes. Em 1994 identificou-se no cromossomo 4p16.1 um dos genes responsáveis pela SW, que foi denominado WFS1 ou wolframina. Esse gene codifica uma proteína de 890 aminoácidos de localização no retículo endoplasmático. A função da proteína wolframina ainda não está completamente definida, porém sua localização no retículo endoplasmático sugere um papel na regulação da homeostase do cálcio, transporte de membrana ou processamento protéico. O entendimento de como alterações na função da wolframina resultam em diabetes e neurodegeneração é essencial para o desenvolvimento de terapias para prevenir ou atenuar as conseqüências da SW.
Familial history of type 2 diabetes in patients from Southern Brazil and its influence on the clinical characteristics of this disease
Authors: Crispim Daisy , Canani Luís H. , Gross Jorge L. , Tschiedel Balduíno , Souto Kátia E.P. , Roisenberg Israel
Published: December 2006

OBJECTIVE: To investigate the presence of maternal and paternal history of type 2 diabetes mellitus (DM) in relatives of 644 type 2 diabetic patients from Southern Brazil, and also to evaluate its influence on the clinical characteristics of this disease. PATIENTS AND METHODS: Familial history of type 2 DM was investigated by a questionnaire. The maternal and paternal history was investigated over two generations. Complete data sets on familial history were obtained from 396 patients. RESULTS: In general, 76.6% of the patients reported at least one first-degree affected relative. Besides, 31.6% of the patients reported a maternal history of type 2 DM and 12.6% reported a paternal history. Patients with maternal and/or paternal history presented a lower age at type 2 DM diagnosis when compared to patients without familial history. In addition, patients with only paternal history presented a higher frequency of hypertension than patients with no familial history. CONCLUSIONS: This study suggests that there is a significant maternal effect in the transmission of type 2 DM in Southern Brazil, and that most of the clinical characteristics of this disease do not differ between patients with or without familial history of type 2 DM.
Utilidade da medida de PTH intra-operatório no tratamento cirúrgico do hiperparatiroidismo primário e secundário: análise de 109 casos
Authors: Ohe Monique Nakayama , Santos Rodrigo Oliveira , Kunii Ilda Shizue , Abrahão Márcio , Cervantes Onivaldo , Carvalho Aluízio Barbosa , Lazaretti-Castro Marise , Vieira José Gilberto H.
Published: December 2006

INTRODUÇÃO: A medida de PTH intra-operatório (PTH-IO) foi inicialmente descrita em 1988, sendo potencialmente útil na definição de sucesso após a paratiroidectomia. OBJETIVOS: Avaliar prospectivamente perfil de decaimento do PTH-IO e sua capacidade de prever sucesso cirúrgico no hiperparatiroidismo primário (HPP) e secundário à insuficiência renal (HPS). PACIENTES E MÉTODOS: 109 pacientes operados entre 06/2000 e 12/2004, sendo 33 HPP, 76 HPS (52 em diálise, 24 transplantados renais). PTH-IO: método imunométrico rápido (Elecsys-PTH/Immunoassay-Roche); tempo para resultado: 10 minutos. Coletas de sangue periférico nos tempos basal, 10 e 20 minutos pós-paratiroidectomia. RESULTADOS: HPP: queda média de PTH de 79,2% aos 10 minutos. HPS: queda média de PTH de 85,8% e 87,6% aos 10 minutos nos pacientes diálise e transplantados respectivamente. A cirurgia foi bem sucedida em todos, exceto em 2 pacientes (1 HPP, 1 HPS). Em ambos não houve queda PTH-IO, sendo constatado adenoma duplo no HPP e paratiróide ectópica no HPS. CONCLUSÃO: Medida PTH-IO fornece resultados confiáveis em tempo rápido, sendo capaz de discriminar persistência da doença se mantidos níveis elevados.
Irregularidade do ciclo menstrual no menacme como marcador para fatores de risco cardiovasculares na pós-menopausa
Authors: Azevedo George D. , Duarte João-Marcelo B.P. , Souza Maxwell O. , Costa-e-Silva Thiago D.N. , Soares Elvira M.M. , Maranhão Técia M.O.
Published: December 2006

A associação entre fatores de risco cardiovascular (FRCV) na pós-menopausa e o antecedente de irregularidade menstrual no menacme foi avaliado em estudo caso-controle envolvendo 414 mulheres na pós-menopausa com idade de 60,4 ± 5,5 anos e IMC de 25,3 ± 4,7 kg/m². As variáveis consideradas foram: caracterização do ciclo menstrual entre 20 e 35 anos (independente) e relato atual sobre ocorrência de hipertensão arterial, dislipidemia, diabetes mellitus e doença arterial coronariana (dependentes). Utilizou-se o teste qui-quadrado e modelos de regressão logística, ajustados para outras variáveis implicadas no risco para doenças CV, com nível de significância 5%. Observou-se que mulheres que relataram irregularidade menstrual prévia estiveram associadas com risco aumentado para ocorrência de algum FRCV [odds ratio ajustado (OR)= 2,14; IC-95%= 1,024,48], quando comparadas àquelas com ciclos regulares. Análise estratificada demonstrou as seguintes associações significativas com o antecedente de irregularidade menstrual: hipertensão arterial (OR= 2,4; 95% IC= 1,395,41), hipercolesterolemia (OR= 2,32; 95% IC= 1,174,59), hipertrigliceridemia (OR= 2,09; 95% IC= 1,104,33) e angioplastia coronariana (OR= 6,82; 95% IC= 1,4432,18). Os dados sugerem que o antecedente de irregularidade menstrual, indicativo da ocorrência da síndrome dos ovários policísticos na idade reprodutiva, pode estar relacionado com aumento do risco para doenças CV na pós-menopausa.
Resultados do tratamento cirúrgico na acromegalia com um único neurocirurgião e meta-análise cumulativa
Authors: Boeving Anke , Borba Luiz Alencar , Rodrigues Adriane Maria , Orichowski Elisa Brunner , Paz Filho Gilberto Jorge da , Santos Carlos M. Correa dos , Boguszewski César Luiz
Published: December 2006

Avaliamos retrospectivamente os resultados da cirurgia transesfenoidal num grupo de acromegálicos operados por um único neurocirurgião, comparando-os com uma meta-análise cumulativa de 10 séries (1.632 pacientes) publicadas entre 1992-2005. Estudamos 28 pacientes (17M/11F; 44,1 ± 12,7 anos; 27 com macroadenomas, sendo 86% invasivos), acompanhados por 21,4 ± 17,6 meses após a cirurgia; eles foram classificados de acordo com a atividade da acromegalia em: 1) doença controlada (DC): GH basal ou médio < 2,5 ng/ml ou GH nadir no TTOG < 1ng/ml e IGF-1 normal; 2) não controlada (DNC): GH basal ou médio > 2,5 ng/ml ou nadir no TTOG > 1 ng/ml e IGF-1 elevado; 3) inadequadamente controlada (DIC): GH normal e IGF-1 elevado ou GH elevado e IGF-1 normal. Após a cirurgia, os níveis de GH reduziram de 61,7 ± 101,1 ng/ml para 7,2 ± 13,7 ng/ml (p< 0,001), e os de IGF-1 de 673,1 ± 257,7 ng/ml para 471,2 ± 285 ng/ml (p= 0,01). A taxa de remissão bioquímica foi de 57% [10 pacientes (35,5%) com DC e 6 (21,5%) com DIC], similar àquela obtida na meta-análise de cirurgias de macroadenomas. Sete dos 28 pacientes foram submetidos à re-intervenção (4 operados em outro hospital e 3 pelo nosso neurocirurgião), sendo 5 (71,5%) classificados como DC no pós-operatório. Invasão de seio cavernoso foi mais prevalente nos DNC e DIC, e desvio de haste hipofisária no grupo DNC. A taxa de remissão foi maior nas séries em que apenas um único cirurgião realizou os procedimentos (66% vs. 49%; p< 0,05). Em conclusão, esses dados comprovam que a experiência do neurocirurgião pode aumentar significativamente as taxas de remissão do tratamento cirúrgico da acromegalia, especialmente em tumores maiores e mais invasivos, e que a re-intervenção realizada por cirurgião experiente deve ser considerada nos algoritmos de abordagem terapêutica desta doença.
Transtorno da compulsão alimentar periódica em uma população de obesos mórbidos candidatos a cirurgia bariátrica do Hospital Universitário Oswaldo Cruz, em Recife - PE
Authors: Petribu Kátia , Ribeiro Edilana Sá , Oliveira Fabiana M.F. de , Braz Cristiana I.A. , Gomes Maria Laura Mota , Araujo Daniella E. de , Almeida Nair C.N. de , Albuquerque Pedro C. de , Ferreira Moacir de N.L.
Published: December 2006

OBJETIVOS: Avaliar a freqüência de transtorno da compulsão alimentar periódica (TCAP) e dos principais transtornos psiquiátricos associados à obesidade mórbida em indivíduos à espera de cirurgia bariátrica. MÉTODOS: Estudo de corte transversal. Foram entrevistados pacientes do programa de cirurgia da obesidade do Hospital Universitário Oswaldo Cruz e avaliados o perfil sócio-demográfico, a qualidade de vida (escala SF-36), o TCAP (Binge Eating Scale BES) e os transtornos psiquiátricos (Mini International Neuropsychiatry Interview M.I.N.I./DSM-IV). RESULTADOS: Dos 400 pacientes inscritos no programa, 67 (16,8%) foram entrevistados. O IMC variou de 36,1 a 81,8 kg/m² (média 48,5 ± 8,8). Todos os entrevistados apresentavam doenças associadas, sendo a HAS, os distúrbios do sono e as osteopatias as mais freqüentes. Os transtornos psiquiátricos mais freqüentes foram: 47,8% transtorno de ansiedade generalizada; 29,9% depressão atual e 34,3% depressão no passado. Verificou-se TCAP em 56,7% dos pacientes (25,4% TCAP moderado e 31,3%, grave) e esses apresentaram os piores escores em todos os domínios de qualidade de vida da escala SF-36. CONCLUSÕES: Constatou-se elevada prevalência de TCAP. Grupo com TCAP apresentou maior número de tratamentos realizados com objetivo de perder peso, elevada prevalência de depressão maior no momento da avaliação, piores escores em todos os domínios da escala de qualidade de vida SF-36. Visto que os portadores de TCAP apresentam vasta psicopatologia e maior probabilidade de comprometimento nos resultados da cirurgia, deve-se aprimorar a detecção desses distúrbios a fim de proporcionar-lhes o tratamento adequado.