bluuebunny/crossref_metadata_2025 huggingface dataset:
Rotational Form in the Opening Scene of Gershwin's Porgy and Bess
Authors: DAVIS ANDREW , POLLACK HOWARD
Published: November 2007

Although George Gershwin's Porgy and Bess has the reputation of being casually constructed and amenable to cuts, a close look at the unexpurgated opera—including its first scene, the focus of this essay—reveals a through-composed work of considerable architectural complexity. Specifically, the opening scene may be understood as a rotational form—a large-scale organizational strategy in which thematic materials are restated cyclically—exhibiting teleological genesis—a procedure by which the form leads the listener gradually toward a goal-point or climax. In this particular case, two alternating themes eventually conjoin to form the subject of a climactic fugue, thereby closely tracing the scene's dramatic design, in which a craps game degenerates into violence and murder. The presence of rotational form in this scene, among other criteria, suggests that abridged versions of the opera, including the one premiered by New York's Theatre Guild in 1935, need to be reconsidered, especially with regard to the work's motivic, tonal, and formal coherence as well as its proportion and pacing.
Viewers' Interpretations of Film Characters' Emotions: Effects of Presenting Film Music Before or After a Character is Shown
Authors: Tan Siu-Lan , Spackman Matthew P. , Bezdek Matthew A.
Published: November 2007

STUDIES ADDRESSING EFFECTS OF MUSIC ON VIEWERS' perceptions of film have usually presented music simultaneously with a scene of interest. In the present study, 177 undergraduates viewed film excerpts with music presented before or after a scene featuring a single character. Whereas the film characters had emotionally neutral or subdued facial expressions, the music conveyed happiness, sadness, fear, or anger. Overall, participants tended to interpret characters' emotions in ways that were consistent with the particular emotion expressed in the music, offering evidence for both forward and backward affective priming effects. Our data confirm Boltz, Schulkind, and Kantra's (1991) findings on the role of music in foreshadowing. As far as we are aware, the effects of music on a prior scene have not been demonstrated in film music research. Our findings suggest that music does not have to be presented concurrently with onscreen images to influence viewers' interpretations of film content.
Poor-Pitch Singing in the Absence of "Tone Deafness"
Authors: Pfordresher Peter Q. , Brown Steven
Published: November 2007

THE TERM "TONE DEAFNESS," COMMONLY APPLIED TO poor-pitch singing, suggests that the cause lies in faulty perception. However, it is also plausible that problems lie in production, memory, and/or sensorimotor integration. We report the results of two experiments on vocal pitch imitation that addressed these possibilities. Participants listened to and then vocally imitated unfamiliar 4-note pitch sequences.Within each experiment, 10-15% of the participants imitated pitch at least one semitone off and were categorized as "poor-pitch singers." Such deviations were reliable across different pitch classes and therefore constitute transpositions. In addition, poor-pitch singers compressed the size of intervals during production. Poor-pitch singers did not differ from good singers in pitch discrimination accuracy, although they appeared to be hindered rather than helped by singing with correct accompaniment. Taken together, findings suggested that poor-pitch singing results from mismapping of pitch onto action, rather than problems specific to perceptual,motor, or memory systems.
Comparison of Harvest Control Policies for Rebuilding Overfished Populations within a Fixed Rebuilding Time Frame
Authors: Babcock Elizabeth A. , McAllister Murdoch K. , Pikitch Ellen K.
Published: November 2007

U.S. law requires that overfished fish populations be rebuilt within 10 years when biologically possible, and otherwise within the time it would take to rebuild in the absence of fishing plus one mean generation time (MGT). Most overfished populations can recover in less than 10 years; the exceptions are populations with very low productivity and some that are severely depleted. A range of harvest control policies, including constant fishing mortalities and variable harvest rate control rules, were compared in terms of their ability to rebuild overfished populations of five species within the required times. The North Atlantic swordfish Xiphias gladius and Gulf of Mexico red snapper Lutjanus campechanus populations were able to rebuild in 10 years, but the white marlin Tetrapturus albidus, sandbar shark Carcharhinus plumbeus, and darkblotched rockfish Sebastes crameri populations were not. The harvest policy that resulted in populations being rebuilt most rapidly was either a control rule that reduced fishing mortality with decreasing biomass or a constant harvest rate designed to meet the current rebuilding time requirement. The control rules we analyzed restricted catches at the beginning of the rebuilding period but allowed catches to increase rapidly as the population was rebuilt. Thus, there was a trade-off between relatively high catches early in the rebuilding period and high catches later in the rebuilding period when the population had been rebuilt and could sustain high catches. Whether the population was rebuilt more rapidly under a fixed rebuilding-time requirement or a control rule depended on the productivity of the population.
Adiponectin gene and cardiovascular risk in type 2 diabetic patients: a review of evidences
Authors: Ferrarezi Daniela A.F. , Cheurfa Nadir , Reis André F. , Fumeron Frédéric , Velho Gilberto
Published: November 2007

Diabetic patients have a 3-fold higher risk of developing atherosclerosis and its clinical complications as compared to non-diabetic individuals. Part of the cardiovascular risk associated with diabetes is probably due to genetic determinants influencing both glucose homeostasis and the development of atherosclerosis. However, type 2 diabetes frequently coexists with other cardiovascular risk factors like arterial hypertension, central obesity and dyslipidemia. Genetic variability affecting many areas such as lipid and energy metabolisms, hypertension and haemodynamic mechanisms, blood clotting homeostasis, inflammation, and matrix turnover in the vascular wall will have an impact on the development of macrovascular complications in diabetic patients. Adiponectin is abundantly secreted by adipocytes. It plays important roles in lipid and glucose metabolisms and has direct anti-inflammatory and anti-atherogenic effects. In this review, we summarize recent data from the literature suggesting an implication of allelic variations of the adiponectin gene (ADIPOQ) in the genetic determinants of cardiovascular disease in diabetic subjects.
Left ventricle diastolic dysfunction in diabetes: an update
Authors: Freire Cláudia Maria V. , Moura Ana Luiza M.T. , Barbosa Márcia de Melo , Machado Lucas José de C. , Nogueira Anelise Impeliziere , Ribeiro-Oliveira Jr. Antônio
Published: November 2007

Diabetes mellitus, a disease that has been reaching epidemic proportions, is an important risk factor to the development of cardiovascular complication. Diabetes causes changes within the cardiac structure and function, even in the absence of atherosclerotic disease. The left ventricular diastolic dysfunction (VE) represents the earliest pre-clinical manifestation of diabetic cardiomyopathy, preceding the systolic dysfunction and being able to evolve to symptomatic heart failure. The doppler echocardiography has emerged as an important noninvasive diagnostic tool, providing reliable data in the stages of diastolic function, as well as for systolic function. With the advent of recent echocardiographic techniques, such as tissue Doppler and color M-mode, the accuracy in identifying the moderate diastolic dysfunction, the pseudonormal pattern, has significantly improved. Due to cardiometabolic repercussions of DM, a detailed evaluation of cardiovascular function in diabetic patients is important, and some alterations may be seen even in patients with gestational diabetes.
Alterações das propriedades funcionais e estruturais de grandes artérias no diabetes mellitus
Authors: Bortolotto Luiz Aparecido
Published: November 2007

Alterações funcionais e estruturais das grandes artérias exercem um importante papel na patogênese das doenças cardiovasculares. O diabetes mellitus, ao lado da hipertensão arterial e do envelhecimento, pode induzir essas alterações em diferentes territórios arteriais, e assim levar ao desenvolvimento de aterosclerose e suas conseqüências cardiovasculares. A principal alteração da função das grandes artérias é o aumento da rigidez, enquanto que a principal alteração estrutural é o maior espessamento da camada intima-media da artéria carótida, encontradas em ambos os tipos 1 e 2 de diabetes. Os mecanismos destas alterações estruturais e funcionais arteriais no diabetes incluem a resistência à insulina, o acúmulo de colágeno devido à glicação enzimática inadequada, disfunção endotelial e do sistema nervoso autônomo. O aumento de rigidez arterial é um marcador de risco cardiovascular em pacientes diabéticos, e o tratamento tanto do diabetes per se quanto de dislipidemia e hipertensão arterial associadas pode modificar beneficamente essas alterações arteriais.
Disfunção autonômica cardiovascular no diabetes mellitus experimental
Authors: De Angelis Katia , Schaan Beatriz D'Agord , Rodrigues Bruno , Malfitano Christiane , Irigoyen Maria Cláudia
Published: November 2007

Muitas informações novas têm sido publicadas nos últimos anos a respeito da fisiopatologia da disfunção autonômica cardiovascular em ratos e camundongos diabéticos. Nosso grupo tem estudado o curso temporal das alterações cardiovasculares associadas ao diabetes experimental há alguns anos, obtendo evidências consistentes de grave disautonomia em modelos animais de diabetes. O objetivo deste trabalho foi revisar a contribuição que estudos envolvendo diferentes modelos de deficiência e resistência à insulina têm fornecido para o entendimento, tratamento e prevenção da disfunção autonômica cardiovascular do diabetes.
Nefropatia diabética e doença cardíaca
Authors: Gross Jorge Luiz , Silveiro Sandra Pinho , Canani Luís Henrique , Friedman Rogério , Leitão Cristiane Bauermann , Azevedo Mirela Jobim de
Published: November 2007

Pacientes em diferentes estágios de nefropatia diabética (ND) apresentam freqüentemente comprometimento cardíaco expresso por isquemia miocárdica e/ou cardiomiopatia diabética. Estas alterações já estão presentes em estágios iniciais da ND e provavelmente mesmo antes de a excreção urinária de albumina (EUA) atingir níveis tradicionalmente diagnósticos de microalbuminúria. As alterações cardíacas são responsáveis por uma proporção significativa de mortes nos pacientes com ND e podem ser reduzidas através de intervenção nos múltiplos fatores de risco cardiovascular encontrados nesses pacientes. A avaliação de doença cardíaca deve idealmente ser realizada em todos os pacientes com qualquer grau de ND através de métodos específicos para detectar isquemia e disfunção miocárdica, além do emprego rotineiro da monitorização ambulatorial da pressão arterial em 24 h. Em pacientes com aterosclerose avançada também devem ser avaliadas outras artérias (carótidas, aorta, renais). O tratamento rigoroso da hipertensão arterial, o uso de fármacos cardioprotetores, o tratamento da dislipidemia e da anemia, assim como o emprego de medicamentos anti-plaquetários, poderão reduzir a elevada mortalidade cardiovascular na ND.
Estado atual do tratamento da coronariopatia crônica em pacientes diabéticos: evidências e controvérsias baseadas em ensaios clínicos
Authors: Lopes Neuza H. , Tsutsui Jeane M. , Hueb Whady A.
Published: November 2007

Diabetes mellitus é um dos principais fatores de risco para a doença arterial coronária. A doença progride de forma mais acelerada em pacientes diabéticos e está associada com pior prognóstico. Embora a revascularização miocárdica garanta alívio rápido dos sintomas em pacientes com doença arterial coronária documentada, não existe substancial evidência de benefício prognóstico, salvo em situações anatômicas específicas. Adicionalmente, o benefício das terapias de revascularização é atenuado pela presença de anormalidades metabólicas secundárias à resistência à insulina e significantes co-morbidades. Nos últimos anos, avanços na terapêutica clínica (estatinas, antiplaquetários potentes, novos anti-hipertensivos) e técnicas de revascularização cirúrgica e percutânea ocorreram, sendo que o emprego de stents farmacológicos parece ser uma promissora opção terapêutica nesses pacientes. A estratégia de tratamento do paciente diabético com coronariopatia crônica deve levar em consideração a patogênese multifatorial da doença e visar uma intervenção agressiva do controle dos níveis glicêmicos e de todos os fatores de risco modificáveis, aliada à mudança no estilo de vida. Os efeitos não-metabólicos dos sensibilizadores de insulina sobre a vasculopatia e mortalidade nesses pacientes também estão em discussão. Estudos clínicos em andamento deverão definir o impacto das novas modalidades terapêuticas sobre o prognóstico dos pacientes diabéticos.
Hiperaldosteronismo primário causado por aldosteronoma: problemas no diagnóstico etiológico
Authors: Danilovic Debora Lucia S. , Freire Daniel Soares , Paraíba Diane Belchior , Brandão Neto Rodrigo A. , Lucon Antônio Marmo , Pereira Maria Adelaide A.
Published: November 2007

O hiperaldosteronismo primário (HAP) representa importante causa de hipertensão arterial secundária, potencialmente curável, que tem recebido atenção recente em função do aumento de sua prevalência desde a introdução do rastreamento pelo uso da relação aldosterona/atividade plasmática de renina. Apresentamos caso de HAP causado por provável aldosteronoma, coexistente com adenoma adrenal não-funcionante contra-lateral, o que dificultou o diagnóstico etiológico. Discutimos as formas mais apropriadas de rastrear, confirmar o diagnóstico de HAP e diferenciar as suas diversas etiologias, com destaque para o papel do cateterismo de adrenais no diagnóstico diferencial definitivo entre aldosteronoma e hiperaldosteronismo idiopático, com implicações no sucesso terapêutico.
Discordância entre IGF-1 e GH pós-sobrecarga de glicose no rastreamento de acromegalia em paciente com macroprolactinoma: relato de caso e revisão sobre o tema
Authors: Gonçalves Fabrícia Torres , Feibelmann Taciana C. Maia , Fernandes Maria Luiza M. P. , Fonseca Alessandra R.C. , Arantes Henrique Pierotti , Jorge Paulo Tannús
Published: November 2007

Neste artigo, descrevemos o caso de um paciente com diagnóstico de macroprolactinoma, que apresentava valores discordantes entre IGF-1 (elevado) e GH (hormônio de crescimento) pós-teste de tolerância oral à glicose (normal) realizados para pesquisa de co-secreção de GH pelo tumor. Houve normalização dos níveis de prolactina após uso de bromocriptina, porém, durante o acompanhamento, o paciente persistiu com níveis elevados de IGF-1 sem clínica aparente, sugerindo tratar-se de possível forma subclínica de acromegalia. Após o desenvolvimento de novos métodos laboratoriais, mais sensíveis, para a dosagem de GH, casos de discordância entre esses testes vêm sendo observados, levando alguns autores a sugerir que o nadir de GH pós-teste de tolerância à glicose oral (TTGO) para diagnóstico e tratamento da acromegalia pode ser bem menor do que o limite considerado atualmente (1,2). Assim, se isto for confirmado, casos subclínicos ou oligossintomáticos de acromegalia serão diagnosticados mais precocemente.
Ensaios para a medida de hormônio do crescimento (GH) e IGF-I: aspectos metodológicos e suas implicações no diagnóstico e seguimento da acromegalia
Authors: Casagrande Alessandra , Czepielewski Mauro A.
Published: November 2007

A dosagem do GH no soro é essencial para confirmar ou excluir o seu excesso. Na acromegalia, a ausência de critérios clínicos suficientemente sensíveis para monitorizar o sucesso do tratamento faz com que o GH sérico seja o procedimento de escolha e, para isso, é essencial que a sua dosagem seja realizada de forma confiável, capaz de permitir interpretações uniformes. Vários critérios hormonais têm sido propostos para caracterizar remissão da acromegalia, incluindo níveis séricos de GH randômico inferior a 2,5 µg/l, nadir de GH durante o teste de tolerância oral a glicose inferior a 1,0 µg/l e IGF-I normal para sexo e idade. A importância do tratamento adequado consiste na possibilidade de reverter a mortalidade prematura da acromegalia através da diminuição dos níveis de GH para valores menores que 2,5 µg/l. Com o surgimento de ensaios ultra-sensíveis para medida do GH, tornaram-se necessários critérios mais estritos para determinar cura ou remissão da doença. Nesta revisão, descreveremos aqui as modificações decorrentes da evolução dos ensaios, as conseqüências nos resultados de GH e os pontos de corte propostos na literatura para caracterização da atividade e remissão da acromegalia.
Farmacogenética e efeito antiinflamatório dos inibidores da HMG-CoA redutase
Authors: Rosendo Alexandre B. , Dal-Pizzol Felipe , Fiegenbaum Marilu , Almeida Silvana de
Published: November 2007

A aterosclerose é resultado da associação de uma deposição de lipídios na parede arterial e um processo inflamatório de baixo grau. Essa inflamação pode ser detectada através da dosagem de marcadores séricos, que indicam o grau de aterosclerose, e estão associados a um maior risco de desenvolvimento de doenças cardiovasculares, independentemente dos níveis lipídicos. Entre estes marcadores destaca-se a Proteína C reativa ultra-sensível. As estatinas reduzem a inflamação associada à aterosclerose, o que é verificado por uma redução dos valores de proteína C reativa. Parte desse efeito está associada à diminuição de proteínas isopreniladas, porém as estatinas possuem efeitos diretos no sistema imune. Variações genéticas individuais estão associadas a variações no efeito hipolipemiante das estatinas, porém pouco se sabe sobre as variantes que interferem com as ações antiinflamatórias desses medicamentos. Além dos genes envolvidos no metabolismo do colesterol, genes que influenciam a farmacocinética e a farmacodinâmica das estatinas são possíveis responsáveis pela variação do efeito antiinflamatório observado.
New perspectives on the treatment of differentiated thyroid cancer
Authors: Coelho Sabrina Mendes , Carvalho Denise Pires de , Vaisman Mário
Published: November 2007

Even though differentiated thyroid carcinoma is a slow growing and usually curable disease, recurrence occurs in 20-40% and cellular dedifferentiation in up to 5% of cases. Conventional chemotherapy and radiotherapy have just a modest effect on advanced thyroid cancer. Therefore, dedifferentiated thyroid cancer represents a therapeutic dilemma and a critical area of research. Targeted therapy, a new generation of anticancer treatment, is planned to interfere with a specific molecular target, typically a protein that is believed to have a critical role in tumor growth or progression. Since many of the tumor-initiation events have already been identified in thyroid carcinogenesis, targeted therapy is a promising therapeutic tool for advanced thyroid cancer. Several new drugs are currently being tested in in vitro and in vivo studies and some of them are already being used in clinical trials, like small molecule tyrosine kinase inhibitors. In this review, we discuss the bases of targeted therapies, the principal drugs already tested and also options of redifferentiation therapy for thyroid carcinoma.
Molecular genetics of papillary thyroid carcinoma: great expectations...
Authors: Trovisco Vítor , Soares Paula , Preto Ana , Castro Patrícia , Máximo Valdemar , Sobrinho-Simões Manuel
Published: November 2007

Papillary thyroid carcinoma (PTC) is the most prevalent type of endocrine cancer and, in recent epidemiological surveys, one of the types of human cancer whose incidence is growing. Despite the favourable outcome and long survival rates of most patients, some tumours display an aggressive behaviour and may progress to the highly aggressive and lethal, anaplastic thyroid carcinoma. In recent years, several progresses have been made on the molecular characterization of PTC, in general, and in the genetic alterations underlying the histotype diversity of this type of cancer, in particular. This holds true regarding alterations on nuclear DNA as well as mitochondrial DNA. In this review we have summarized the most recent findings in the genetic characterization of PTC, giving a particular emphasis to the genotype-phenotype associations, the prognosis implications, and the diagnostic and therapeutic value of the newly identified genetic markers.
TSH signalling and cancer
Authors: García-Jiménez Custodia , Santisteban Pilar
Published: November 2007

Thyroid cancers are the most frequent endocrine neoplasms and mutations in the thyrotropin receptor (TSHR) are unusually frequent. Here we present the state-of-the-art concerning the role of TSHR in thyroid cancer and discuss it in light of the cancer stem cell theory or the classical view. We briefly review the gene and protein structure updating the cancer related TSHR mutations database. Intriguingly, hyperfunctioning TSHR mutants characterise differentiated cancers in contrast to undifferentiated thyroid cancers which very often bear silenced TSHR. It remains unclear whether TSHR alterations in thyroid cancers play a role in the onset or they appear as a consequence of genetic instability during evolution, but the presence of functional TSHR is exploited in therapy. We outline the signalling network build up in the thyrocyte between TSHR/PKA and other proliferative pathways such as Wnt, PI3K and MAPK. This network’s integrity surely plays a role in the onset/evolution of thyroid cancer and needs further research. Lastly, future investigation of epigenetic events occurring at the TSHR and other loci may give better clues for molecular based therapy of undifferentiated thyroid carcinomas. Targeted demethylating agents, histone deacetylase inhibitors combined with retinoids and specific RNAis may help treatment in the future.
Polimorfismos genéticos: implicações na patogênese do carcinoma medular de tireóide
Authors: Rocha Andreia Possatti da , Magalhães Patrícia K. Ribeiro , Maia Ana Luiza , Maciel Lea Maria Zanini
Published: November 2007

O carcinoma medular de tireóide (CMT) é uma neoplasia maligna rara, ocorrendo na forma esporádica ou hereditária. Mutações germinativas no proto-oncogene RET são responsáveis pelo CMT hereditário. No entanto, a maioria dos casos de CMT ocorre em indivíduos sem história familiar, na qual a patogênese da doença ainda é pouco compreendida. Os polimorfismos do gene RET são descritos na população geral assim como em pacientes com CMT. Embora estas variações alélicas aparentemente não confiram qualquer atividade transformadora no receptor RET, estudos sugerem que essas alterações genéticas podem modificar a suscetibilidade à doença e o fenótipo clínico em pacientes com CMT esporádico ou hereditário. Uma maior freqüência dos polimorfismos localizados nos exons 11 (G691S), 13 (L769L), 14 (S836S) e 15 (S904) é descrita em pacientes com CMT provenientes de países americanos e europeus. Na presente revisão, analisamos criticamente os resultados obtidos nos diferentes estudos e descrevemos a freqüência dos polimorfismos do RET em pacientes brasileiros com CMT esporádico.
Carcinoma não medular familiar da tiróide
Authors: Santos Roberto Bernardo , Melo Thaís Gomes de , Assumpção Lígia V. Montali
Published: November 2007

O carcinoma diferenciado da tiróide, papilífero ou folicular, origina-se da célula folicular tiroideana, sendo a neoplasia maligna mais freqüente desta glândula. Desde 1955 têm sido relatados casos de agrupamento familiar deste carcinoma, e atualmente estima-se que 4,2% de todos os carcinomas diferenciados da tiróide tenham origem familiar. Esses casos costumam ser mais agressivos, incidem em idade mais precoce, são multifocais e apresentam maior taxa de recorrência. Parecem ser transmitidos por herança autossômica dominante com penetrância variável, mas os genes exatos responsáveis pela doença ainda não foram totalmente identificados. Os pacientes devem ser tratados com tiroidectomia total e freqüentemente também com esvaziamento linfonodal cervical, seguidos de ablação com iodo radioativo e terapia supressiva do TSH com levotiroxina. Alguns autores recomendam rastreamento de familiares de primeiro grau dos pacientes afetados através da ultrassonografia cervical, com objetivo de realizar diagnóstico precoce, possibilitando melhores resultados terapêuticos.
Investigação de linfonodos em pacientes em seguimento por carcinoma diferenciado de tiróide
Authors: Biscolla Rosa Paula M.
Published: November 2007

Recorrências regionais dos carcinomas diferenciados de tiróide (CDT) são representadas por linfonodos cervicais em 60-75% dos casos. Com a introdução da ultra-sonografia cervical (USC) no seguimento dos pacientes com carcinoma papilífero de tiróide (CPT) tornou-se freqüente o encontro de pequenos linfonodos (LNs) cervicais. Porém, apesar da USC apresentar alta sensibilidade, o estudo citológico obtido por punção aspirativa (PAAF), e nos últimos anos, a dosagem da tiroglobulina (Tg) no lavado da agulha da PAAF (Tg-PAAF), vêm assumindo papel importante no diagnóstico de LNs cervicais. O objetivo deste estudo é revisar a importância do diagnóstico precoce das metástases em linfonodos cervicais no seguimento dos pacientes com carcinoma de tiróide.
O ensaio de tiroglobulina com melhor sensibilidade funcional enquanto os pacientes tomam L-T4 substituirá a tiroglobulina estimulada pelo TSH no seguimento dos pacientes com câncer diferenciado da tiróide?
Authors: Maciel Rui M.B.
Published: November 2007

O autor apresenta evidências recentes da literatura que mostram que ensaios de tiroglobulina sérica (sTg) com maior sensibilidade funcional apresentam a mesma qualidade que a obtenção da sTg estimulada por rhTSH ou hipotiroidismo, no seguimento de pacientes com câncer diferenciado de tiróide (CDT). Desta forma, propõe modificar a prática recomendada pelas diretrizes de sociedades internacionais para o seguimento desses pacientes (desenvolvidas enquanto os ensaios disponíveis apresentavam sensibilidade de 1 ng/mL), substituindo-se a obtenção da sTg estimulada por rhTSH ou hipotiroidismo pelo acompanhamento dos pacientes na vigência da terapia com L-T4 com a medida da sTg desde que se empreguem técnicas com sensibilidade funcional da ordem de 0,1-0,2 ng/mL.
High-sensitivity C-reactive protein in subjects with type 2 diabetes mellitus and/or high blood pressure
Authors: Lima Luciana M. , Carvalho Maria das Graças , Soares Anna L. , Sabino Adriano de P. , Fernandes Ana P. , Novelli Bethânia A. , Sousa Marinez O.
Published: November 2007

Type 2 diabetes mellitus (DM2) and high blood pressure (HBP) may contribute to the development of cardiovascular disease, and inflammation may be an important factor in these diseases. In the present study, plasma levels of high-sensitivity C-reactive protein (hs-CRP) were measured in subjects with DM2 and/or HBP and compared to those of normal subjects. Eighty-nine subjects were analyzed for hs-CRP, including 13 normotensive patients with DM2, 17 patients with HBP, 34 hypertensive patients with DM2 (DM2+HBP) and 25 normal subjects. The plasma hs-CRP levels were significantly lower in the controls than in the HBP+DM2 group (p < 0.05). DM2 associated with HBP was also correlated with increased plasma hs-CRP levels (n = 89, r = 0.25, p = 0.0162). Only hypertensive patients with DM2 had higher levels of hs-CRP, a circulating inflammatory marker, than normal subjects. This finding suggests that patients with two associated diseases have a more active inflammatory state.
Efeito do exercício físico na sensibilidade à insulina em mulheres obesas submetidas a programa de perda de peso: um ensaio clínico
Authors: Mediano Mauro Felippe Felix , Barbosa José Silvio de Oliveira , Sichieri Rosely , Pereira Rosângela Alves
Published: November 2007

O objetivo deste estudo foi de avaliar o efeito do exercício sobre a sensibilidade insulínica, metabolismo lipídico e perda de peso em mulheres submetidas a programa de redução ponderal. Realizou-se ensaio clínico com 40 mulheres obesas (IMC de 30,41 a 53,29 kg/m²), incluindo 20 em cada grupo. Ambos os grupos (intervenção e controle) receberam orientação nutricional e apoio psicológico. O grupo de intervenção também realizou três sessões semanais de exercícios físicos durante 20 semanas. As variáveis antropométricas foram medidas em três momentos. A análise através de medidas repetidas (modelo linear misto) mostrou redução de 2 kg peso corporal (p = 0,02) e de 0,88 kg/m² no Índice de Massa Corporal (p = 0,02), ao final de 20 semanas, do grupo intervenção comparado ao controle. Não foram encontradas diferenças significativas entre os grupos para variáveis relativas à localização da gordura corporal (circunferência de cintura e relação cintura-quadril), perfil lipídico e sensibilidade insulínica medida pelo HOMA-IR. Os ácidos graxos livres apresentaram elevação no grupo intervenção comparado ao controle (diferença entre os grupos = 0,30 mmol/L; p = 0,002). A inclusão de exercícios no programa de redução do peso promoveu maior redução ponderal, aumentou os AGLs, mas não alterou a sensibilidade insulínica em mulheres obesas.
As novas definições e classificações dos estados intersexuais: o que o Consenso de Chicago contribui para o estado da arte?
Authors: Damiani Durval , Guerra-Júnior Gil
Published: November 2007

As anomalias da diferenciação sexual têm-se constituído em um formidável desafio quanto ao diagnóstico e à conduta, colocando o paciente, os familiares e os profissionais da equipe de saúde na difícil situação de definir a melhor opção quanto ao gênero de criação. Uma terminologia confusa e estigmatizante tem sido adotada e, nesse sentido, o Consenso de Chicago propõe várias modificações no sentido de minimizar os desconfortos graças a uma terminologia que nem sempre auxilia na solução de problemas. Os autores fazem uma análise crítica da classificação sugerida pelo Consenso, levantando a questão de que, na nova classificação, também não se resolvem certos problemas terminológicos e continua a se criar algum grau de estigmatização. Em primeiro lugar, a sugestão de se incluir o cariótipo no nome da doença supõe, erroneamente, que os pacientes não tenham conhecimento do que significa ser 46,XY ou 46,XX. Uma criança criada no sexo feminino com uma anomalia da diferenciação sexual (ADS) 46,XY não vai entender porque está no sexo feminino se seu cariótipo é "masculino". A substituição do termo hermafroditismo verdadeiro por ADS ovotesticular está longe de resolver o problema de estigmatização causado por "hermafroditismo". O termo ovotesticular é claramente entendido como uma fusão entre ovário e testículo e não será aceito com "naturalidade". Se, por um lado, é muito satisfatório que a questão da nomenclatura seja discutida, por outro lado devemos escolher termos alternativos que sejam realmente neutros e não tragam, em si, a conotação de um sexo que pode não condizer com o escolhido para aquele paciente em particular. Um ponto em que todos concordamos é que a substituição de intersexo por anomalia da diferenciação sexual (ADS) ou, disorder of sex development (DSD), na língua inglesa, cai muito melhor e não dá a conotação de um "sexo intermediário" como o nome antigo proporcionava.
Intensive insulin therapy versus conventional glycemic control in patients with acute neurological injury: a prospective controlled trial
Authors: Azevedo José Raimundo A. de , Lima Eduardo Rodrigues M. , Cossetti Rachel Jorge Dino , Azevedo Renato Palácio de
Published: November 2007

OBJECTIVE: To compare intensive insulin therapy to conventional glycemic control in patients with acute neurological injury evaluating neurological outcome and morbimortality. METHOD: Patients with two glycemias above 150 mg/dL 12 hours after admission were randomized to receive intensive insulin therapy (G1) or conventional treatment (G2). We evaluated a subgroup of patients with acute brain injury from July, 2004 to June, 2006. RESULTS: G1 patients (n=31) received 70.5 (45.1-87.5) units of insulin/day while G2 patients (n=19) received 2 (0.6-14.1) units/day (p<0.0001). The median glycemia was comparable in both groups (p=0.16). Hypoglycemia occurred in 2 patients (6.4%) in G1 and in 1 patient (5.8%) in G2 (p=1.0). Mortality in G1 was of 25.8% and of 35.2% in G2 (relative reduction of 27%). Neurological outcome was similar in both groups. CONCLUSION: A less strict intensive insulin therapy can reduce hypoglycemia and still maintain its benefits.
Optimized hyperventilation preserves 2,3-diphosphoglycerate in severe traumatic brain injury
Authors: Torres Rayne Borges , Terzi Renato Giuseppe Giovanni , Falcão Antônio Luís Eiras , Höehr Nelci Fenalti , Dantas Filho Venâncio Pereira
Published: November 2007

INTRODUCTION: The concentration of 2,3-diphosphoglycerate (2,3-DPG/Hct) increases as a physiological occurrence to pH increase and hyperventilation. This response was tested in patients with severe traumatic brain injury (TBI). METHOD: The concentration of 2,3-DPG/Hct was measured daily for six days in eleven patients with severe TBI in need of optimized hyperventilation because of intracranial hypertension. RESULTS:There was correlation between pH and the concentration of DPG/Hct. The concentration of 2,3-DPG/Hct remained predominantly within normal levels with slight increase in the sixth day of the study. The concentration of 2,3-DPG/Hct correlated significantly with measured partial pressure of oxygen that saturates 50% the hemoglobin of the blood (P50st), confirming the consistency of our data. CONCLUSION: The expected physiological response of a progressive increase in concentration of 2,3-DPG/Hct to hyperventilation was not observed. This fact may be explained by the intermittent and not sustained hyperventilation as dictated by the protocol of optimized ventilation.
Race, gender and stroke subtypes mortality in São Paulo, Brazil
Authors: Lotufo Paulo A. , Goulart Alessandra C. , Bensenor Isabela M.
Published: November 2007

Stroke mortality rates have a discrepant distribution according to socioeconomic variables as social exclusion in Brazil. Recently, data from race has been available from the official health statistics considering five categories: White, Mixed, Black, Asian and Native. We addressed in the city of São Paulo, Brazil, an analysis of cerebrovascular mortality according to race (excluding Asian and Native due to small number of events) and gender during 1999-2001 for people aged 30 to 79 years-old. For all cerebrovascular diseases, age-adjusted mortality rates (x 100,000) for men were higher for Black (150.2), intermediate for Mixed (124.2) and lower for White (104.5) people. These gradient patterns were similar for all stroke subtypes, except for subarachnoideal hemorrhage in which no differences were detected. For women, the rates were lower compared to men and the same pattern was observed among Black (125.4), Mixed (88.5) and White (64.1) women. Compared to White men, the risk ratio of Black men was 1.4. However, compared to White women, the risk ratio for Black women was 2.0. Concluding, there is a significant gradient of stroke mortality according to race, mainly among women.
Treatment of trigeminal neuralgia with low doses of topiramate
Authors: Domingues Renan Barros , Kuster Gustavo Wruck , Aquino Camila Catherine Henriques
Published: November 2007

Topiramate was administered to eight patients with classical trigeminal neuralgia with or without previous symptomatic therapy with other antiepileptic drugs. The topiramate doses ranged from 50 to 100 mg a day, according to the clinical response and the reported side effects. Three patients had complete symptoms remission, three reported moderate improvement, and the treatment was not effective in two. The most frequently registered side effects were dizziness, somnolence and weight loss. Topiramate can be considered an alternative treatment for patients with trigeminal neuralgia.
C3c intrathecal synthesis evaluation in patients with multiple sclerosis
Authors: Padilla-Docal Bárbara , Dorta-Contreras Alberto J , Fundora-Hernández Hermes , Noris-García Elena , Bu-Coifiu-Fanego Raisa , González-Hernández Marlen , Rodríguez-Rey Alexis
Published: November 2007

INTRODUCTION: Multiple sclerosis (MS) is a chronic, inflammatory and progressive disease of the central nervous system in which local inflammatory injuries of the brain white matter appears, being the most outstanding feature the myeline loss (demyelination). OBJECTIVE: To determine if the complement system might be involved in the MS immunopathogeny favouring the mechanism intervening in the myelin destruction. METHOD: Samples of sera and CSF from twelve patients with a diagnosis of MS obtained at the moment of the admission to the hospital at the beginning of the break out, were collected. Levels of C3c and albumin in sera and in CSF were quantified using radial immunodiffusion plates. RESULTS: High values over 80% of intrathecal synthesis were obtained except in one of the patients. CONCLUSION: Intrathecal synthesis of C3c and its liberation to the CSF means that the activation of the complement system in any of the two ways has taken place, and that once performed its biological functions, has suffered a degradation process.
Neuroprotective effect of mild hypothermia in the temporary brain ischemia in cats
Authors: Nakano Hiroshi , Colli Benedicto Oscar , Lopes Luiza da Silva
Published: November 2007

OBJECTIVE: To evaluate the neuroprotective effect of mild hypothermia during temporary focal ischemia in cats. METHOD: 20 cats underwent middle cerebral artery 60 minutes occlusion and 24 hours reperfusion: 10 under normothermia and 10 under mild hypothermia (32º C). Brain coronal sections 2mm thick were stained with 2,3,5-triphenyltetrazolium hydrochloride, photographed and evaluated with software for volume calculation. RESULTS:Cortical ischemia was found in 7 and basal ganglia ischemia in 8 animals of group 1 and in both regions in 5 animals of group 2 (no difference: p=0.6499 for cortical; p=0.3498 for basal ganglia). No ischemia was found in 5 animals of group 2 and in none of group 1 (significant difference, p=0.0325). The infarct volume was greater in group 1 than 2 (p=0.0433). CONCLUSION: Mild hypothermia did not interfere with location of ischemia, but it was effective for reducing the infarct volume.
Trigeminal sensory neuropathy and facial contact dermatitis due to Anthurium sp
Authors: Twardowschy Carlos A. , Teive Hélio A.G. , Siquineli Fábio , Ditzel Filho Léo , Entres Marlene , Twardowschy André , Werneck Lineu César
Published: November 2007

BACKGROUND: Trigeminal sensory neuropathy (TSN) describes a heterogeneous group of disorders manifesting as facial numbness. OBJECTIVE: We report the case of a patient who had TSN associated with contact dermatitis due to Anthurium sp. METHOD/RESULTS: A 21-year-old female patient developed left hemifacial contact dermatitis after exposure to the anthurium plant. The patient had paresthesias and pain in the V2 and V3 divisions of the left trigeminal nerve. Eight days after its onset the dermatitis resolved, but numbness developed in the V2 and V3 divisions of the left trigeminal nerve. Cranial CT scan and MRI, as well as CSF and extensive work-up exams, were normal. After one month the symptoms disappeared completely. CONCLUSION: Anthurium sp, an indoor ornamental plant that contains calcium oxalate crystals, and can causes contact dermatitis. To our knowledge, this is the first report associating TSN with contact dermatitis due to Anthurium sp.
Peroneal nerve palsy due to compartment syndrome after facial plastic surgery
Authors: Godeiro-Júnior Clécio O. , Oliveira Acary Sousa Bulle , Felício André Carvalho , Barros Newton , Gabbai Alberto Alain
Published: November 2007

A 25-year-old white man, right after bilateral rhytidoplasty, presented with agitation, necessiting use of haloperidol. Some hours after, he developed severe pain in his legs and a diagnosis of neuroleptic malignant syndrome (NMS) was considered. Even with treatment for NMS he still complained of pain. A diagnosis of lower limb compartment syndrome (CS) was done only 12 hours after the initial event, being submitted to fasciotomy in both legs, disclosing very pale muscles, due to previous ischemia. This syndrome was not explained only by facial surgery, his position and duration of the procedure. It can be explained by a sequence of events. He had a history of pain in his legs during physical exercises, usually seen in chronic compartment syndrome. He used to take anabolizant and venlafaxine, not previously related, and the agitation could be related to serotoninergic syndrome caused by interaction between venlafaxine and haloperidol. Rhabdomyolisis could lead to oedema and ischmemia in both anterior leg compartment. This report highlights the importance of early diagnosis of compartment syndrome, otherwise, even after fasciotomy, a permanent disability secondary to peripheral nerve compression could occur.
McArdle disease with rhabdomyolysis induced by rosuvastatin: case report
Authors: Lorenzoni Paulo José , Silvado Carlos Eduardo , Scola Rosana Herminia , Luvizotto Mario , Werneck Lineu César
Published: November 2007

The rosuvastatin inducing rhabdomyolysis in McArdle disease (MD) has not been reported to date. A 35-years-old man had exercise intolerance, muscular fatigue and cramps during physical activity since infancy. He presented severe rhabdomyolysis episode with seizure and coma after use of rosuvastatin. The investigation showed increased serum creatinekinase levels and the forearm ischemic exercise did not increased venous lactate. The muscle biopsy showed subsarcolemmal and central acummulation of glycogen and absence of the myophosphorylase enzyme. The statin induced myopathy is discussed and the danger of its use in MD is emphasized.
Synovial cyst of the thoracic spine: case report
Authors: Oliveira Helio A. , Jesus Alan Chester F. de , Prado Roberto César P. , Santos Augusto César E. , Sobral Paulo Marcelo S. , Oliveira Arthur Maynart P. , Marcena Sonia Maria L. , Silveira Douglas Rafaele A.
Published: November 2007

Spinal cord compressing syndrome due to synovial cyst (SC) of the thoracic spine is a rare clinic condition. We report a case of SC located in the thoracic spine causing spastic paraparesis in a 14 year-old female patient. The SC was removed thoroughly by laminectomy. The patient had an excellent recovery. The etiological and therapeutic aspects are discussed.
Schistosomiasis mansoni presenting as a cerebellar tumor: case report
Authors: Silva Joacil Carlos da , Lima Frederico de Melo Tavares de , Vidal Cláudio Henrique , Azevedo Filho Hildo Cirne Rocha de
Published: November 2007

The Manson's schistosomiasis tumoral form rarely affects the brain. There are only 12 cases prior related with a mean age of 25 years and a male predominance. We describe a 16-year-old Brazilian Northeastern boy with a cerebellar mass lesion. The radiological aspect was considered compatible with glioma and a gross total resection was performed. Microscopic examination disclosed intraparenchymal granulomas surrounding Schistosoma mansoni eggs. The case is compared with the literature findings and some peculiar aspects of this trematode infection are reviewed.
SUNCT syndrome: report of a possible symptomatic case
Authors: Rodrigues Guilherme Gustavo Riccioppo , Bordini Carlos Alberto , Dach Fabíola , Eckeli Alan , Speciali José Geraldo
Published: November 2007

SUNCT is one of the rarest and least known primary headache disorders. Although its pathogenesis has been partially understood by functional neuroimaging and reports of secondary cases, there is limited understanding of its cause. We report a case of SUNCT in a 54-years-old man, that could not be strictly classified as secondary SUNCT; however, the time lag of pain onset suggests a new theory in which neuroplasticity could be involved in the origin and duration of the pain in SUNCT syndrome.
Hemifacial spasm in a patient with neurofibromatosis and Arnold-Chiari malformation: a unique case association
Authors: Felício Andre Carvalho , Godeiro-Junior Clecio de Oliveira , Borges Vanderci , Silva Sonia Maria de Azevedo , Ferraz Henrique Ballalai
Published: November 2007

BACKGROUND: The association of hemifacial spasm (HFS), Chiari type I malformation (CIM) and neurofibromatosis type 1 (NF1) has not been described yet. CASE REPORT: We report the case of a 31-year-old woman with NF1 who developed a right-sided HFS. On magnetic resonance imaging (MRI) a CIM was seen without syringomyelia. The patient has been successfully treated with botulinum toxin type A injections for 5 years without major side effects. CONCLUSION:Clinical features of HFS, CMI and NF1 are highlighted together with their possible relationship. Also, therapeutic strategies are also discussed.
Pontine and extrapontine osmotic myelinolysis after the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) associated with fluoxetine: case report
Authors: Twardowschy Carlos Alexandre , Bertolucci Cristina Buselatto , Gracia Cleverson de Macedo
Published: November 2007

Osmotic demyelination syndrome (ODS) may be precipitated by aggressive correction of a hypo or hyper-osmolar states. We describe the case of a 53-year-old woman that was started on fluoxetine 20 mg/day for depression and nine days later was found to have fluoxetine-induced syndrome of inappropriate secretion of antidiuretic hormone. After hyponatremia correction the mental status of the patient gradually improved, but subsequently she had intermittent difficulty in speaking, naming objects, memory deficits and psychomotor slowness. Magnetic resonance revealed bilateral symmetric hyperintense lesions in the basal ganglia, temporal lobe and hippocampal formation compatible with ODS. These symptoms gradually resolved and she was discharged home without any deficits. Two months later, a new image showed lesion in pons and the other lesions had disappeared. Fluoxetine therapy had never been related with a complication like that.
Relação entre degeneração do trato córtico-espinhal através de ressonância magnética e escala funcional (ALSFRS) em pacientes com esclerose lateral amiotrófica
Authors: Garcia Larissa Nery , Silva Alexandre Vallota da , Carrete Jr Henrique , Favero Francis Meire , Fontes Sissy Veloso , Moneiro Marcelo Tavares , Oliveira Acary Souza Bulle de
Published: November 2007

A esclerose lateral amiotrófica (ELA) é doença neurodegenerativa que afeta o trato córtico-espinhal. A escala funcional de avaliação em ELA (ALSFRS) é um questionário que quantifica clinicamente as perdas motoras, enquanto a imagem por tensor de difusão (DTI) avalia a integridade das fibras através da fração de anisiotropia (FA). No presente estudo, sete pacientes com ELA definida foram avaliados pela ALSFRS e imediatamente submetidos à DTI, obtendo valores de FA nas regiões: pedúnculo cerebral (PC), cápsula interna (CI) e substância barnca subjacente às áreas motora primária (M1), motora secundária (M2) e somestésica (SI). Um grupo controle foi constituído de doze indivíduos saudáveis. Os pacientes apresentaram valores de FA significativamente menores que os controles, com tendência à maior redução à direita e nas regiões mais caudais. Curiosamente, os valores de FA estavam reduzidos na área somestésica. Não foi observada correlação entre a duração dos sintomas e os valores de FA. Apesar da correlação entre os valores da ALSFRS e a degeneração em PC e CI, nossos resultados sugerem que essa escala subjetiva não é um bom parâmetro para a avaliação do dano estrutural nas porções encefálicas do trato corticoespinhal.