Dioxin Exposure, from Infancy through Puberty, Produces Endocrine Disruption and Affects Human Semen Quality

BACKGROUND: Environmental toxicants are allegedly involved in decreasing semen quality in recent decades; however, definitive proof is not yet available. In 1976 an accident exposed residents in Seveso, Italy, to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD). OBJECTIVE: The purpose of this study was to investigate reproductive hormones and sperm quality in exposed males. METHODS: We studied 135 males exposed to TCDD at three age groups, infancy/prepuberty (1-9 years), puberty (10-17 years), and adulthood (18-26 years), and 184 healthy male comparisons using 1976 serum TCDD levels and semen quality and reproductive hormones from samples collected 22 years later. RESULTS: Relative to comparisons, 71 men (mean age at exposure, 6.2 years; median serum TCDD, 210 ppt) at 22-31 years of age showed reductions in sperm concentration (53.6 vs. 72.5 million/mL; p = 0.025); percent progressive motility (33.2% vs. 40.8%; p < 0.001); total motile sperm count (44.2 vs. 77.5 x 10(6); p = 0.018); estradiol (76.2 vs. 95.9 pmol/L; p = 0.001); and an increase in follicle-stimulating hormone (FSH; 3.58 vs. 2.98 IU/L; p = 0.055). Forty-four men (mean age at exposure, 13.2 years; median serum TCDD, 164 ppt) at 32-39 years of age showed increased total sperm count (272 vs. 191.9 x 10(6); p = 0.042), total motile sperm count (105 vs. 64.9 x10(6); p = 0.036), FSH (4.1 vs. 3.2 UI/L; p = 0.038), and reduced estradiol (74.4 vs. 92.9 pmol/L; p < 0.001). No effects were observed in 20 men, 40-47 years of age, who were exposed to TCDD (median, 123 ppt) as adults (mean age at exposure, 21.5 years). CONCLUSIONS: Exposure to TCDD in infancy reduces sperm concentration and motility, and an opposite effect is seen with exposure during puberty. Exposure in either period leads to permanent reduction of estradiol and increased FSH. These effects are permanent and occur at TCDD concentrations < 68 ppt, which is within one order of magnitude of those in the industrialized world in the 1970s and 1980s and may be responsible at least in part for the reported decrease in sperm quality, especially in younger men

The role of lung metastasis resection in improving outcome of colorectal cancer patients: Results from a large retrospective study

BACKGROUND: The role of surgery for lung metastases (LM) secondary to colorectal cancer (CRC) remains controversial. The bulk of evidence is derived from single surgical series, hampering any definitive conclusions. The aim of this study was to compare the outcomes of CRC patients with LM submitted to surgery with those who were not. PATIENTS AND METHODS: Data from 409 patients with LM as the first evidence of advanced disease were extracted from a database of 1,411 patients. Patients were divided into three groups: G1, comprised of 155 patients with pulmonary and extrapulmonary metastases; G2, comprised of 104 patients with LM only and no surgery; G3, comprised of 50 patients with LM only and submitted to surgery. RESULTS: No difference in response rates emerged between G1 and G2. Median progression-free survival (PFS) times were: 10.3 months, 10.5 months, and 26.2 months for G1, G2, and G3, respectively. No difference in PFS times was observed between G1 and G2, whereas there was a statistically significant difference between G2 and G3. Median overall survival times were 24.2 months, 31.5 months, and 72.4 months, respectively. Survival times were longer in resected patients: 17 survived >5 years and three survived >10 years. In patients with LM only and no surgery, four survived for 5 years and none survived >10 years. CONCLUSIONS: Even though patients with resectable LM are more likely to be those with a better outcome, our study provides evidence suggesting an active role of surgery in improving survival outcomes in this patient subset

Recomendaciones para el tratamiento de las pacientes con diabetes pregestacional. Sociedad Argentina de Diabetes - Grupo Latinoamericano de Diabetes y Embarazo

La diabetes mellitus (DM) pregestacional afecta al desarrollo de la gestación y se asocia a complicaciones maternas y fetoneonatales. Si bien hace algunos años la mayoría de las pacientes con diabetes pregestacional (DPG) eran diabéticas tipo 1, la prevalencia de mujeres con diabetes tipo 2 en edad reproductiva ha aumentado, asociada al incremento de obesidad. La paciente con DPG con mal control tiene mayor riesgo de complicaciones desde el inicio y hasta el final del embarazo. El control metabólico adecuado, el correcto estado nutricional y el tratamiento de las complicaciones maternas previenen las complicaciones o reducen su severidad. Por ello es fundamental la programación del embarazo para prevenir el daño en las primeras semanas de gestación. Además, es necesario el riguroso seguimiento clínico durante todo el embarazo. En este contexto, mediante el estudio de evidencias científicas y estudios vinculados, surgen estas recomendaciones para mujeres con diabetes pregestacional.Pregestational DM affects normal gestation and is associated with maternal and fetal-neonatal complications. Although a few years ago most of the patients with pregestational diabetes had type 1 diabetes, the prevalence of type 2 diabetes in women in childbearing age has increased, associated with an increase in obesity. Patients with poorly controlled pregestational diabetes are at higher Pregestational DM affects normal gestation and is associated with maternal and fetal-neonatal complications. Although a few years ago most of the patients with pregestational diabetes had type 1 diabetes, the prevalence of type 2 diabetes in women in childbearing age has increased, associated with an increase in obesity. Patients with poorly controlled pregestational diabetes are at higher risk of complications from the beginning to the end of pregnancy. Adequate metabolic control, proper nutritional status and treatment of maternal complications prevent complications or reduce their severity. For this reason, pregnancy programming is essential to prevent harm from the first weeks of gestation. In addition, rigorous clinical follow-up is required throughout pregnancy. In this context and through the study of scientific evidences and related studies, these recommendations for women with pregestational diabetes emerge.Fil: Rovira, Maria Gabriela. Hospital Británico de Buenos Aires; ArgentinaFil: Jawerbaum, Alicia Sandra. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Centro de Estudios Farmacológicos y Botánicos. Universidad de Buenos Aires. Facultad de Medicina. Centro de Estudios Farmacológicos y Botánicos; Argentina. Hospital Materno Infantil de San Isidro; ArgentinaFil: Glatstein; Liliana. Universidad Nacional de Córdoba; ArgentinaFil: Sucani, Stella. Universidad Nacional de Córdoba; ArgentinaFil: Bertona, Celina. Hospital Universitario de Mendoza; ArgentinaFil: Argerich, Maria Inés. Hospital Perupato; ArgentinaFil: Gomez Martin, Carolina. Centro Integral de Endocrinologíay Diabetes ; ArgentinaFil: Tedesco, Jorge Fabián. Hospital San Martín; ArgentinaFil: Capobianco, Evangelina Lorena. Universidad de Buenos Aires; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Rivas, Eugenia. Gobierno de la Ciudad Autonoma de Buenos Aires. Hospital Materno Infantil Ramon Sarda; ArgentinaFil: Rodríguez, María Elena. Hospital Materno Infantil de San Isidro; ArgentinaFil: Basualdo, María Natalia. Gobierno de la Ciudad Autonoma de Buenos Aires. Hospital Materno Infantil Ramon Sarda; Argentina. Universidad de Carabobo.; VenezuelaFil: Alvariñas, Jorge. Hospital Enrique Tornu; ArgentinaFil: Salzberg, Susana. Instituto Centenario; ArgentinaFil: Faingold, María Cristina. Hospital Dr. César Milstein; ArgentinaFil: Gorban de Lapertosa, Silvia Beatriz. Universidad Nacional del Nordeste. Facultad de Medicina; ArgentinaFil: Rivas Blasco, Aleida. Hospital Materno Infantil de San Isidro Carlos Giannantonio; ArgentinaFil: Rodríguez, María Elena. Hospital Materno Infantil de San Isidro Carlos Giannantonio; ArgentinaFil: Mendes, Patricio. Policlinico Neuquén; ArgentinaFil: Marmol, Marta. No especifíca;Fil: Falcon de Legal, Edith. Universidad Nacional de Asunción; ParaguayFil: Ribeiro Gama, Mirnaluci Paulino. Hospital Universitario Evangélico de Curitiba; BrasilFil: Barbero, Roxana. Centro Integral de Medicina, Endocrinología y Diabetes; BrasilFil: Barragán, Derek. Hospital San Gabriel; Bolivi