Long term compensatory sweating results after sympathectomy for palmar and axillary hyperhidrosis

Endoscopic thoracic sympathectomy is currently the best treatment for primary upper extremity hyperhidrosis, but the potential for adverse effects, particularly the development of compensatory sweating, is a concern and often precludes surgery as a definitive therapy. This study aims to evaluate long-term results of two-stage unilateral versus one-stage bilateral thoracoscopic sympathectomy

Salvage resection of advanced mediastinal tumors

The surgical treatment of locally advanced mediastinal tumors invading the great vessels and other nearby structures still represent a tricky question, principally due to the technical complexity of the resective phase, the contingent need to carry out viable vascular reconstructions and, therefore, the proper management of pathophysiologic issues. Published large-number series providing oncologic outcomes of patients who have undergone extended radical surgery for invasive mediastinal masses are just a few. Furthermore, the wide variety of different histologies included in some of these studies, as well as the heterogeneity of chemo and radiation therapies employed, did not allow for the development of clear oncologic guidelines. Usually in the past, surgical resections of large masses along with the neighbouring structures were not offered to patients because of related morbidity and mortality and limited information available on the prognostic advantage for long term. However, in the last decades, advances in surgical technique and perioperative management, as well as increased oncologic experience in this field, have allowed radical exeresis in selected patients with invasive tumors requiring resections extended to the surrounding structures and complex vascular reconstructions. Such aggressive surgical treatment has been proposed in association or not with adjuvant chemo- or radiotherapy regimens, achieving encouraging oncologic results with limited morbidity and mortality in experienced institutions. Congestive heart failure or impending cardiovascular collapse due to the compression by the large mass are the most frequent immediately lifethreatening problems that some of these patients can experience. In this setting, medical palliation is usually ineffective and an aggressive salvage surgical treatment may remain the only therapeutic option

Left ventricular diastolic dysfunction in normotensive postmenopausal women with type 2 diabetes mellitus.

Background The prevalence of heart failure among diabetic patients is high, also in those with normal blood pressure and without coronary artery disease, even when electrocardiogram (ECG) is normal. The goal of our study was to assess the prevalence of left ventricular diastolic dysfunction (LVDD) among diabetic women (DW) and its correlation with glycosylated hemoglobin (HbA1c) levels, obesity status, and ECG parameters. Methods : A group of 456 consecutive normotensive postmenopausal women affected by type 2 diabetes, diagnosed over 5 years, were enrolled. One hundred normotensive non-diabetic postmenopausal women were included as a control group (CG). Rest ECG and trans-thoracic echocardiogram and Doppler were performed. Results : LVDD was present in 103 (23.3%) out of 456 DW, and 8 out of 100 women in CG (8%), p < 0.001. There was no difference in mean age between the two groups: 56 ± 13 and 55 ± 3, respectively (p = 0.3). There were 191 (41.9 %) DW with body mass index (BMI) > 30 kg/m2. Among those, there were 56 (12.3%) with significant prevalence of LVDD, while there were 49 (10.7%) with BMI < 30 kg/m2, p < 0.005. DW with HbA1c > 7.5% comprised a group of 243 (53.3%) patients. Among those, there were 45 (9.9%) with higher prevalence of LVDD, and 15 (3.3%) with HbA1c < 7.5%), p < 0.01. Out of a group of 147 (32.2%) DW with abnormal ECG , 21 had LVDD (4.6%), p = 0,1, and 84 (18.8%) had LVDD with normal ECG. Conclusions: Our data prove a high prevalence of LVDD in asymptomatic diabetic postmenopausal women. This finding is closely related with HbA1c levels and obesity status, not with abnormal ECG, which is a unique cardiologic test recommended by current guidelines in all diabetic patients. We conclude that early detection of high level of HbA1c and obesity (30 kg/m2) may identify women with major risk to develop LVDD. Furthermore, a simple ECG, when normal, is not enough to assess a normal LV diastolic function

Left ventricular diastolic dysfunction in normotensive postmenopausal women with type 2 diabetes mellitus

Background: The prevalence of heart failure among diabetic patients is high, also in those with normal blood pressure and without coronary artery disease, even when electrocardiogram (ECG) is normal. The goal of our study was to assess the prevalence of left ventricular diastolic dysfunction (LVDD) among diabetic women (DW) and its correlation with glycosylated hemoglobin (HbA1c) levels, obesity status, and ECG parameters. Methods: A group of 456 consecutive normotensive postmenopausal women affected by type 2 diabetes, diagnosed over 5 years, were enrolled. One hundred normotensive non-diabetic postmenopausal women were included as a control group (CG). Rest ECG and trans-thoracic echocardiogram and Doppler were performed. Results: LVDD was present in 103 (23.3%) out of 456 DW, and 8 out of 100 women in CG (8%), p < 0.001. There was no difference in mean age between the two groups: 56 ± 13 and 55 ± 3, respectively (p = 0.3). There were 191 (41.9%) DW with body mass index (BMI) > 30 kg/m2. Among those, there were 56 (12.3%) with significant prevalence of LVDD, while there were 49 (10.7%) with BMI < 30 kg/m2, p < 0.005. DW with HbA1c > 7.5% comprised a group of 243 (53.3%) patients. Among those, there were 45 (9.9%) with higher prevalence of LVDD, and 15 (3.3%) with HbA1c < 7.5%, p < 0.01. Out of a group of 147 (32.2%) DW with abnormal ECG , 21 had LVDD (4.6%), p = 0,1, and 84 (18.8%) had LVDD with normal ECG. Conclusions: Our data prove a high prevalence of LVDD in asymptomatic diabetic postmenopausal women. This finding is closely related with HbA1c levels and obesity status, not with abnormal ECG, which is a unique cardiologic test recommended by current guidelines in all diabetic patients. We conclude that early detection of high level of HbA1c and obesity (30 kg/m2) may identify women with major risk to develop LVDD. Furthermore, a simple ECG, when normal, is not enough to assess a normal LV diastolic function.

Gender-Specific Cytokine Pathways, Targets, and Biomarkers for the Switch from Health to Adenoma and Colorectal Cancer

Studies focusing on gender have shown that differences exist in how the immune system responds to disease and therapy. Understanding how gender influences immunological mechanisms in health and disease and identifying gender-specific biomarkers could lead to specifically tailored treatment and ultimately improve therapeutic success rates. T helper1 (Th1) and Th2 cytokines (Th1/Th2) have pivotal roles in the homeostasis of Th1 and Th2 cell network functions in the immune response but sex steroids affect Th1/Th2 production in different ways and a natural sexual dimorphism in the immune response has been shown. In order to investigate these differences further, we developed Th-cytokine data-driven models of the immune response and evaluated healthy subject peripheral blood samples. Independent cohorts of colorectal cancer and adenoma patients were also studied for comparison purposes. Our results show that the interferon (IFN)γ production pathway for immune response homeostasis is specific to men whilst the interleukin- (IL-) 6 production pathway for immune response homeostasis is specific to women. The IL-10 pathway for restoring immune system resting homeostasis was common to both but was controlled by the respective gender-specific pathways. These gender pathways could well be used as targets and biomarkers in translational research into developing new clinical strategies

Investigação dos casos de doenças febris exantemáticas com IgM reagente contra o sarampo na ausência de transmissão documentada do vírus do sarampo, Estado de São Paulo, 2000-2004

Introdução: Revisar os casos de doenças febris exantemáticas com IgM reagente contra o sarampo, no estado de São Paulo, Brasil, durante os cinco anos seguidos a interrupção da transmissão do vírus do sarampo. Métodos: Nós revisamos 463 casos de doenças febris exantemáticas com IgM reagente contra o sarampo, no estado de São Paulo, Brasil, de 2000 a 2004. Indivíduos vacinados contra o sarampo 56 dias antes da coleta de amostra foram considerados expostos à vacina. Soros da fase aguda e de convalescença foram testados para a evidência de infecção de sarampo, rubéola, parvovírus B19 e herpes vírus 6. Na ausência de soroconversão para imunoglobulina G contra o sarampo, casos com IgM reagente contra o sarampo foram considerados falsos positivos em pessoas com evidência de outras infecções virais. Resultados: Entre as 463 pessoas com doenças febris exantemáticas que testaram positivo para anticorpos IgM contra o sarampo durante o período, 297 (64 por cento) pessoas foram classificadas como expostas à vacina. Entre os 166 casos não expostos à vacina, 109 (66 por cento) foram considerados falsos positivos baseado na ausência de soroconversão, dos quais 21 (13 por cento) tiveram evidência de infecção por vírus da rubéola, 49 (30 por cento) parvovírus B19 e 28 (17 por cento) infecção por herpes vírus humano 6. Conclusões: Após a interrupção da transmissão do vírus do sarampo é necessária exaustiva investigação dos casos com IgM reagente contra o sarampo, especialmente dos casos não expostos à vacina. Testes laboratoriais para etiologias das doenças febris exantemáticas ajudam na interpretação destes casosIntroduction: To review measles IgM-positive cases of febrile rash illnesses in the state of São Paulo, Brazil, over the five-year period following interruption of measles virus transmission. Methods: We reviewed 463 measles IgM-positive cases of febrile rash illness in the state of São Paulo, from 2000 to 2004. Individuals vaccinated against measles ≤ 56 days prior to specimen collection were considered to be exposed to the vaccine. Serum from the acute and convalescent phases was tested for evidence of measles, rubella, parvovirus B19 and human herpes virus-6 infection. In the absence of seroconversion to measles immunoglobulin-G, measles IgM-positive cases were considered false positives in individuals with evidence of other viral infections. Results: Among the 463 individuals with febrile rash illness who tested positive for measles IgM antibodies during the period, 297 (64 per cent) were classified as exposed to the vaccine. Among the 166 cases that were not exposed to the vaccine, 109 (66 per cent) were considered false positives based on the absence of seroconversion, among which 21 (13 per cent) had evidence of rubella virus infection, 49 (30 per cent) parvovirus B19 and 28 (17 per cent) human herpes virus-6 infection. Conclusions: Following the interruption of measles virus transmission, thorough investigation of measles IgM-positive cases is required, especially among cases not exposed to the vaccine. Laboratory testing for etiologies of febrile rash illness aids interpretation of these case

GÊNERO MASCULINO E SAÚDE

This literature review aims to offer elements to broaden discussion on the construction of male identity and its relation with mens health injuries. The health-disease process is also determined by the individuals behavior in society, thus understanding the construction of a male identity from cultural elements, can contribute for the reflection on the existing relation between man and his health. Researchers and public policy makers have not considered the socialization process as a factor that increases mens vulnerability. Nurses should get closer to men considering them as allied, partners and holders of a cultural inheritance that can offer (if creatively and wisely used) strategies to deconstruct negative aspects and rebuild or reinforce positive aspects of masculinity.El objetivo de esta revisión de literatura es indicar maneras que nos permitan aumentar la discusión acerca de la formación de la identidad masculina y su relación con el agravio para la salud de los hombres. El proceso salud-enfermedad también es señalado por las conductas de las personas en la sociedad. Así, comenzar por saber de su cultura puede ayudar a reflexionar acerca de la relación que hay entre la conducta de las personas de sexo masculino y su salud. Investigadores y formuladores de políticas públicas de salud están desconsiderando el proceso de socialización como un factor que aumenta la vulnerabilidad de los hombres. Los enfermeros deberían aproximarse más de ellos y considerarlos como aliados, compañeros y dueños de una herencia cultural que, sI trabajada con creatividad y conocimiento, puede ofrecer estrategias para desmontar los aspectos negativos de la masculinidad y reconstruir o enfatizar los aspectos positivos.Esta revisão de literatura tem o propósito de oferecer elementos para ampliar as discussões acerca da construção da identidade masculina e sua relação com os agravos à saúde dos homens. O processo saúde-doença é também determinado pelo comportamento dos indivíduos na sociedade assim, compreender a construção do gênero masculino associando ao comportamento, a partir de um conjunto de elementos culturais pode colaborar com a reflexão a respeito da relação existente entre o comportamento dos homens e sua saúde. Pesquisadores e formuladores de políticas públicas de saúde têm desconsiderado o processo de socialização como um fator que pode aumentar a vulnerabilidade dos homens. Os profissionais de saúde devem considerar os homens, como aliados, companheiros e detentores de uma herança cultural que, se trabalhada com criatividade e conhecimento, pode oferecer estratégias para desconstruir aspectos negativos da masculinidade e reconstruir ou enfatizar seus aspectos positivos

XX males SRY negative: a confirmed cause of infertility

BACKGROUND: SOX9 is a widely expressed transcription factor playing several relevant functions during development and essential for testes differentiation. It is considered to be the direct target gene of the protein encoded by SRY and its overexpression in an XX murine gonad can lead to male development in the absence of Sry. Recently, a family was reported with a 178 kb duplication in the gene desert region ending about 500 kb upstream of SOX9 in which 46,XY duplicated persons were completely normal and fertile whereas the 46,XX ones were males who came to clinical attention because of infertility. METHODS AND RESULTS: We report a family with two azoospermic brothers, both 46,XX, SRY negative, having a 96 kb triplication 500 kb upstream of SOX9. Both subjects have been analyzed trough oligonucleotide array-CGH and the triplication was confirmed and characterised through qPCR, defining the minimal region of amplification upstream of SOX9 associated with 46,XX infertile males, SRY negative. CONCLUSIONS: Our results confirm that even in absence of SRY, complete male differentiation may occur, possibly driven by overexpression of SOX9 in the gonadal ridge, as a consequence of the amplification of a gene desert region. We hypothesize that this region contains gonadal specific long-range regulation elements whose alteration may impair the normal sex development. Our data show that normal XX males, with alteration in copy number or, possibly, in the critical sequence upstream to SOX9 are a new category of infertility inherited in a dominant way with expression limited to the XX background

Targeting Different Transthyretin Binding Sites with Unusual Natural Compounds

Misfolding and aggregation of the transthyretin (TTR) protein leads to certain forms of amyloidosis. Some nutraceuticals, such as flavonoids and natural polyphenols, have recently been investigated as modulators of the self-assembly process of TTR, but they generally suffer from limited bioavailability. To discover innovative and more bioavailable natural compounds able to inhibit TTR amyloid formation, a docking study was performed using the crystallographic structure of TTR. This computational strategy was projected as an adhoc inspection of the possible relationship between binding site location and modulation of the assembly process; interactions with the as-yet-unexplored epigallocatechin gallate (EGCG) sites and with the thyroxine (T4) pocket were simultaneously analyzed. All the compounds studied seem to prefer the traditional T4 binding site, but some interesting results emerged from the screening of an in-house database, used for validating the computational protocol, and of the Herbal Ingredients Targets (HIT) catalogue available on the ZINC database