RESUMO
This paper presents guidelines for the safe outpatient practice of aesthetic surgery. These guidelines have been prepared by the Lombard Association of Plastic Surgery for Outpatients (ALChiPlA), an association confined to board certified plastic surgeons and holders of official authorizations issued by the Lombard ASL to perform outpatient surgery. The cornerstone of these guidelines is the health and safety of patients, who are turning to this type of surgery in ever increasing numbers. This is the first and thus far the only attempt of its kind and its value is increased by the fact that it has been prepared by specialists who have been carrying out this type of surgery in outpatient situations for years.
Assuntos
Procedimentos Cirúrgicos Ambulatórios/normas , Procedimentos de Cirurgia Plástica , Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , HumanosRESUMO
A group of 18 burned patients was excised between days 2 and 5 postburn days, while 20 patients were operated later, between days 25 and 35 postburn. After early excision the wounds covered with meshed grafts contracted to a mean wound size of 56 per cent while the wounds covered with non-meshed grafts contracted to a mean wound size of 64 per cent. After late excision wounds covered with meshed grafts contracted to a mean wound size of 40.5 per cent while wounds covered with non-meshed grafts contracted to a mean wound size of 51.5 per cent. With early excision, meshed grafts grew back to a size of 78.5 per cent while non-meshed grafts grew back to a size of 91 per cent. With late excision, meshed grafts grew back to a size of 69.5 per cent while non-meshed grafts grew back to a size of 75.5 per cent.
Assuntos
Queimaduras/cirurgia , Transplante de Pele/métodos , Cicatrização/fisiologia , Adolescente , Adulto , Idoso , Queimaduras/patologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: To explore the possible link between diabetic nephropathy and the enhanced activity of the polyol pathway, known to occur in IDDM subjects. RESEARCH DESIGN AND METHODS: We studied the effects of the aldose reductase inhibitor tolrestat (200 mg/day) on urinary albumin excretion rate and glomerular filtration rate in 20 IDDM patients with diabetic nephropathy. RESULTS: Six months of placebo treatment produced no significant changes in glomerular filtration rate, urinary albumin excretion rate, and renal plasma flow. Consequently, filtration fraction remained unchanged. During tolrestat treatment, glomerular filtration rate decreased from the basal value of 156 +/- 14 ml.min-1.1.73 m2 to 142 +/- 13.7 ml.min-1.1.73 m2 (P < 0.001) at 2 mo; 128 +/- 12.4 ml.min-1.1.73 m2 (P < 0.001) at 4 mo; and 123.7 +/- 13.0 ml.min-1.1.73 m2 at 6 mo. A significant decrease of urinary albumin excretion rate was observed during the trial (basal values 219 +/- 32.5 vs. 196.9 +/- 28.5 micrograms/min at 2 mo [P < 0.05]; 171.6 +/- 25.5 micrograms/min at 4 mo [P < 0.001]; and 58.6 +/- 19.3 micrograms/min at 6 mo [P < 0.001]). No significant change in renal plasma flow was seen during tolrestat treatment. Filtration fraction significantly decreased in the tolrestat group from the basal value of 0.23 +/- 0.02 to 0.21 +/- 0.01 at 2 mo (P < 0.005); 0.18 +/- 0.02 at 4 mo (P < 0.001); and 0.17 +/- 0.02 at 6 mo (P < 0.001). CONCLUSIONS: The polyol pathway is implicated in hemodynamic changes associated with early diabetic nephropathy, and aldose reductase treatment can positively influence these parameters.
Assuntos
Albuminúria , Aldeído Redutase/antagonistas & inibidores , Diabetes Mellitus Tipo 1/fisiopatologia , Nefropatias Diabéticas/tratamento farmacológico , Nefropatias Diabéticas/fisiopatologia , Taxa de Filtração Glomerular , Naftalenos/uso terapêutico , Adulto , Glicemia/análise , Pressão Sanguínea , Diabetes Mellitus Tipo 1/sangue , Nefropatias Diabéticas/sangue , Método Duplo-Cego , Feminino , Humanos , Rim/irrigação sanguínea , Masculino , Fluxo Sanguíneo Regional , Fatores de TempoRESUMO
In forty healthy subjects with normal glucose tolerance divided by age into four groups (group A, subjects with mean age < 25 years [n = 10]; group B, subjects with mean age < 40 years [n = 9]; group C, subjects with mean age < 60 years [n = 11]; group D, subjects with mean age > 75 years [n = 10]) and were matched for body mass index (BMI), lean body mass (LBM), mean arterial blood pressure, and sedentary life style, we determined the plasma O2- production, reduced to oxidized glutathione level ratio (GSH/GSSG), and plasma membrane microviscosity. Euglycemic hyperinsulinemic (1 mU/kg.min-1 for 120 minutes) glucose clamp with simultaneous D-3-H glucose infusion and indirect calorimetry allowed determination of glucose turnover parameters and substrate oxidation. In the oldest group of subjects, a significant increase in plasma O2-production and membrane microviscosity associated with a significative reduction in glucose disappearance rate (Rd), total body glucose disposal (TBGD), and nonoxidative glucose metabolism was found. In group D subjects (n = 10), all of these changes were correlated with one another. In a multiple regression analysis of the pooled data from all study subjects (n = 40), only plasma O2- production levels displayed a statistically significant relation with TBGD and nonoxidative glucose metabolism. In conclusion, in aged patients a significant relationship between free radical production and insulin action seems to exist.
Assuntos
Envelhecimento/sangue , Insulina/farmacologia , Espécies Reativas de Oxigênio/metabolismo , Adulto , Idoso , Envelhecimento/metabolismo , Glicemia/análise , Feminino , Glucose/metabolismo , Técnica Clamp de Glucose , Humanos , Insulina/sangue , Masculino , Pessoa de Meia-Idade , Análise de RegressãoRESUMO
In healthy subjects (n = 10) and non-insulin-dependent (type II) diabetics (n = 10) matched for age [43.1 +/- 2.2 vs. 41 +/- 4.4 yr, P = not significant (NS)], body mass index (25.1 +/- 1.1 vs. 26 +/- 0.8 kg/m2, P = NS), gender ratio [5 males (M)/5 females (F) vs. 5M/5F], and mean arterial blood pressure (105 +/- 7 vs. 106 +/- 9 mmHg, P = NS), we determined the changes in insulin secretion and action after glutathione infusion (15 mg/min) and the relative increase in the plasma reduced (GSH)/oxidized (GSSG) glutathione ratio. The rise in the plasma GSH/GSSG ratio significantly improved total body glucose disposal in healthy subjects and in diabetic patients. In this latter group, GSH infusion potentiated the beta-cell response to glucose slightly. In controls and diabetics, insulin infusion with a simultaneous increase in the plasma GSH/GSSG ratio significantly enhanced nonoxidative glucose disposal without affecting oxidative glucose metabolism. After glutathione infusion, all metabolic and hormonal changes correlated with a significant decline in plasma membrane microviscosity. In conclusion, the plasma GSH/GSSG ratio seems to play a major role in the modulation of glucose homeostasis mainly in diabetics.
Assuntos
Diabetes Mellitus Tipo 2/metabolismo , Glucose/metabolismo , Glutationa/análogos & derivados , Glutationa/sangue , Adulto , Membrana Eritrocítica/fisiologia , Feminino , Técnica Clamp de Glucose , Teste de Tolerância a Glucose , Dissulfeto de Glutationa , Homeostase , Humanos , Masculino , Valores de Referência , ViscosidadeRESUMO
We demonstrated similar plasma concentrations and urinary losses but lower erythrocyte magnesium concentrations (2.18 +/- 0.04 vs 1.86 +/- 0.03 mmol/L, P less than 0.01) in twelve aged (77.8 +/- 2.1 y) vs 25 young (36.1 +/- 0.4 y), nonobese subjects. Subsequently, aged subjects were enrolled in a double-blind, randomized, crossover study in which placebo (for 4 wk) and chronic magnesium administration (CMA) (4.5 g/d for 4 wk) were provided. At the end of each treatment period an intravenous glucose tolerance test (0.33 g/kg body wt) and a euglycemic glucose clamp with simultaneous [D-3H]glucose infusion and indirect calorimetry were performed. CMA vs placebo significantly increased erythrocyte magnesium concentration and improved insulin response and action. Net increase in erythrocyte magnesium significantly and positively correlated with the decrease in erythrocyte membrane microviscosity and with the net increase in both insulin secretion and action. In aged patients, correction of a low erythrocyte magnesium concentration may allow an improvement of glucose handling.
Assuntos
Glicemia/metabolismo , Magnésio/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Glicemia/análise , Viscosidade Sanguínea , Índice de Massa Corporal , Peptídeo C/sangue , Método Duplo-Cego , Eritrócitos/química , Eritrócitos/fisiologia , Feminino , Glucagon/sangue , Homeostase , Humanos , Insulina/sangue , Resistência à Insulina/fisiologia , Lactatos/sangue , Magnésio/sangue , Magnésio/urina , Masculino , Piruvatos/sangueRESUMO
OBJECTIVE: To evaluate the effect of glutathione infusion on beta-cell response to glucose in elderly people with impaired glucose tolerance (IGT). RESEARCH DESIGN AND METHODS: Ten patients with normal glucose tolerance and 10 patients with IGT were matched for age (mean +/- SE, 72.1 +/- 2.8 vs. 71.0 +/- 3.4 yr), body mass index (23.1 +/- 1.1 vs. 22 +/- 2.1 kg/m2), and sex (6/4 vs. 5/5, men/women) underwent glutathione infusion (10 mg/min) under basal conditions and during 75-g oral glucose tolerance tests and intravenous glucose tolerance tests (0.33 g.kg body wt-1.3 min-1). Patients with IGT were also submitted to euglycemic-hyperinsulemic and hyperglycemic glucose clamps. RESULTS: In subjects with normal glucose tolerance, glutathione infusion failed to affect beta-cell response to glucose. In contrast, glutathione significantly potentiated glucose-induced insulin secretion in patients with IGT. Furthermore, in the latter group studied by hyperglycemic clamps, glutathione infusion significantly potentiated the beta-cell response to glucose when plasma glucose levels varied between 10 and 15 mM. This effect disappeared at plasma glucose levels greater than 15 mM. No effect of glutathione on insulin clearance and action was observed. CONCLUSIONS: Glutathione infusion enhances insulin secretion in elderly people with IGT.
Assuntos
Glicemia/metabolismo , Teste de Tolerância a Glucose , Glutationa/uso terapêutico , Insulina/metabolismo , Idoso , Glucagon/sangue , Glucagon/metabolismo , Técnica Clamp de Glucose , Humanos , Hiperglicemia/sangue , Insulina/sangue , Secreção de Insulina , Fatores de TempoRESUMO
In insulin-dependent (type 1) diabetic subjects (n = 7) with intact hormone response to hypoglycaemia, oxytocin infusion (0.2 mU/min over 60 min) produced significant rises in basal plasma glucagon and adrenaline levels, while it reduced basal plasma cortisol levels. During insulin-induced hypoglycaemia, oxytocin potentiated the increases in plasma glucagon and adrenaline, while an inhibitory effect on plasma cortisol levels was still present. In insulin-dependent (type 1) diabetic subjects (n = 7) with blunted counter-regulatory hormone response to hypoglycaemia, the same dose of oxytocin (0.2 mU/min over 60 min) increased basal plasma glucose and glucagon concentrations and lowered basal plasma cortisol concentration. In the same group of patients, oxytocin delivery (0.2 mU/min), simultaneously to an insulin-induced hypoglycaemia, produced a significant elevation of plasma glucagon and adrenaline concentrations thus enhancing glucose recovery from hypoglycaemia. In conclusion, in insulin-dependent (type 1) diabetic patients, oxytocin delivery enhances plasma glucagon and adrenaline levels in basal conditions and during insulin-induced hypoglycaemia.
Assuntos
Diabetes Mellitus Tipo 1/sangue , Hormônios/sangue , Ocitocina/farmacologia , Adulto , Glicemia/metabolismo , Epinefrina/sangue , Feminino , Glucagon/sangue , Humanos , Hidrocortisona/sangue , Insulina/farmacologia , Masculino , Ocitocina/efeitos adversosRESUMO
Sparteine sulphate, given i.v. as a bolus of 15 mg/ml plus 90 mg in 0.9% NaCl 100 ml over 60 min, increases plasma insulin and decreases plasma glucose and adrenaline in non-insulin dependent (Type II) diabetic subjects. The hypoglycaemic effect was also evident in the presence of a high plasma glucose level produced by Biostator changing glucose infusion from 20.2 +/- 2.8 to 26.4 +/- 4.2 mg.kg-1.min-1 (p less than 0.01), and it was potentiated by simultaneous infusion of arginine. No additional effect of sparteine on the peripheral sensitivity to insulin were detected by the euglycaemic, hyperinsulinaemic glucose clamp technique, as the glucose infusion rate (3.1 +/- 0.8 vs 2.6 +/- 1.2 mg.kg-1.min-1) was not statistically significant different in the last 60 min of the experiment. It is concluded that sparteine sulphate enhances beta-cell secretion, causing a fall in the plasma glucose concentration.
Assuntos
Glicemia/metabolismo , Diabetes Mellitus Tipo 2/tratamento farmacológico , Esparteína/uso terapêutico , Adulto , Idoso , Arginina , Diabetes Mellitus Tipo 2/sangue , Feminino , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Esparteína/administração & dosagem , Esparteína/efeitos adversosRESUMO
A case of "hemicrania continua" after cluster headache in the same subject is described. Indomethacin exerted an absolute, persistent effect on the present headache. Even though our data are insufficient to demonstrate a causal relation between the two forms of headache, they do suggest this real possibility.
Assuntos
Cefaleia Histamínica/complicações , Transtornos de Enxaqueca/diagnóstico , Cefaleias Vasculares/complicações , Feminino , Humanos , Indometacina/uso terapêutico , Pessoa de Meia-Idade , Transtornos de Enxaqueca/complicações , Transtornos de Enxaqueca/tratamento farmacológicoRESUMO
This study aimed at evaluating the influence of sparteine sulfate either upon basal plasma glucose and insulin or glucose-induced insulin secretion in normal man. Thirteen overnight fasted volunteers took part in this study; five of them were submitted to sparteine sulfate bolus (15 mg in 10 ml of saline solution) followed by a slow infusion (90 mg/100 ml X 60 min) and eight subjects underwent two different glucose pulses (20 gr. i.v.) in absence or in presence of sparteine, infused as described above. In basal conditions, along with sparteine infusion, plasma glucose showed a progressive and significant decrease (P less than 0.0001) and plasma insulin was significantly higher from min 10 to 120' (P less than 0.0005-0.001). Even during the glucose-induced insulin secretion, in the presence of sparteine infusion, plasma glucose levels were significantly lower while plasma insulin levels were significantly higher when compared to those observed after glucose alone. The acute insulin response (AIR) was 42 +/- 10 microU/ml after glucose alone vs 67 +/- 9 microU/ml after glucose plus sparteine (P less than 0.05). Total insulinemic areas were significantly different being 1410 +/- 190 vs 2250 +/- 310 microU/ml/min (P less than 0.001) during glucose and glucose plus sparteine infusion, respectively. This study thereby, demonstrates that in normal man sparteine sulfate, administrated by intravenous infusion, is able to increase either basal or glucose-induced insulin secretion.
Assuntos
Insulina/metabolismo , Esparteína/metabolismo , Adulto , Glicemia/análise , Glucose , Humanos , Insulina/sangue , Secreção de Insulina , Masculino , Valores de ReferênciaRESUMO
Many studies have shown that in normal man salmon and porcine CT administration in bolus inhibits the release of TSH, LH, GH, and glucose- or arginine-induced insulin secretion. In the present study we investigated the effects of human synthetic calcitonin (hCT) on glucose- or arginine-induced insulin secretion in man. Twenty-two subjects were submitted to i.v. administration of hCT during glucose or arginine test. In our opinion, the most interesting results are those observed with arginine plus hCT at two different dosages (25 micrograms and 12.5 micrograms infused in 30 min). In fact arginine plus hCT (25 micrograms in 30 min) administration induced a significant increase of glycemia at 5, 10 and 20 min (p less than 0.01) and at 30 min (p less than 0.05) and a significant decrease of IRI at 5, 10, 20 and 30 min (p less than 0.001) and at 45 min (p less than 0.005). The highest plasma CT levels were observed at 15 and 30 min (490 and 540 pg X ml-1). Arginine plus hCT (12.5 micrograms in 30 min) infusion induced a similar significant increase in plasma glucose at 10, and 20 min (p less than 0.05) and at 30 min (p less than 0.01) and a significant decrease of plasma IRI at 10 min (p less than 0.05) at 20 min and 30 min (p less than 0.005). The highest plasma CT levels were reached at 20 min and 30 min (250 and 270 pg X ml-1, respectively). Our results clearly demonstrate that physiologic doses of hCT are able to inhibit arginine induced insulin secretion in normal man. Since insulin induces hypercalcemia and food ingestion increases both insulin and CT, one could hypothesize that CT inhibits insulin secretion thus controlling post-prandial hypercalcemia by its osteotrophic effect and by its action upon calcium redistributed within the cells.
Assuntos
Arginina/farmacologia , Calcitonina/farmacologia , Glucose/farmacologia , Insulina/metabolismo , Glicemia/análise , Calcitonina/sangue , Cálcio/metabolismo , Feminino , Humanos , Secreção de Insulina , MasculinoAssuntos
Bloqueadores dos Canais de Cálcio/uso terapêutico , Cinarizina/uso terapêutico , Transtornos de Enxaqueca/tratamento farmacológico , Piperazinas/uso terapêutico , Adulto , Pressão Sanguínea/efeitos dos fármacos , Cinarizina/análogos & derivados , Cinarizina/farmacologia , Ensaios Clínicos como Assunto , Feminino , Flunarizina , Frequência Cardíaca/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos de Enxaqueca/fisiopatologia , Transtornos de Enxaqueca/prevenção & controleRESUMO
A 53-year-old man had myotonic dystrophy, hyperthyroidism, and Addison's disease, an association not previously reported, to our knowledge. In the literature, at least five cases of hyperthyroidism associated with myotonic dystrophy have been described, but none also had Addison's disease. The presence of thyroid anti-microsomal antibodies and anti-adrenal antibodies suggests that the two endocrine disorders may be autoimmune. In our case, the treatment of the two endocrinopathies caused a reduction of myotonic symptoms.