Lucas Medeiros Burttet

Endothelin-1 levels and albuminuria in patients with type 2 diabetes mellitus☆

AIM To evaluate the relationship of plasma endothelin-1 (ET-1) levels, a marker of endothelial dysfunction, and urinary albumin excretion in patients with type 2 diabetes mellitus (DM). METHODS Cross-sectional study was conducted in 279 patients (132 males, mean age: 58.7+/-11.0 years, mean DM duration: 11.3+/-8.1 years). Urinary albumin excretion, ET-1, and insulin were measured. Insulin sensitivity was estimated by homeostasis model assessment (HOMA-ir) index. RESULTS ET-1 was associated with urinary albumin excretion after controlling for age, gender, body mass index, blood pressure, HbA1c test, and total cholesterol (R=0.436; adjusted R(2)=0.190, P<0.01). Furthermore, there was a progressive increase in plasma ET-1 levels from patients with normoalbuminuria (n=187, 0.92+/-0.50pg/ml), microalbuminuria (n=68, 1.13+/-0.52pg/ml) to macroalbuminuria (n=24, 1.93+/-1.10pg/ml, P<0.01). CONCLUSION There is an independent association of plasma ET-1 levels with urinary albumin excretion. In addition, plasma ET-1 levels started to increase in the normal values of urinary albumin excretion suggesting that in patients with type 2 DM endothelial dysfunction is already present, in urinary albumin excretion values considered normal.

Papel do sistema endotelina na nefropatia diabética

Endothelin System Function in Diabetic Nephropathy. Diabetic Nephropathy (DN) is a major chronic complication of diabetes mellitus (DM), and one of the main causes of new cases for dialysis, being associated with increasing mortality. The main risk factors for DN are hypertension, hyperglycemia, dyslipidemia, and genetic susceptibility. The renin-angiotensin system (RAS) plays an important role in genesis and progression of DN and there is evidence of an interrelationship between this system and the endothelins. Endothelins are powerful vasoconstrictor peptides and act as modulators of vasomotor tone, cell proliferation, and hormone production. These peptides act through two types of receptors (ET-A and ET-B) and are expressed on endothelial cells and vascular smooth-muscle cells. Activation of this receptor in renal cells leads to a complex signaling cascade resultanting in stimulation of mesangial cell hypertrophy, proliferation, contraction, and extracellular matrix accumulation. These hemodinamic renal alterations are associated with the onset and progress of renal disease in DM. Elevated endothelin-1 (ET-1) levels have been reported in patients with DM. There is evidence suggesting that an increase in the production of ET-1 leads to glomerular damage. The use of ET receptor antagonists has been reported as renoprotective, correcting the early hemodynamic abnormalities in experimental DM, reinforcing the importance of this system in DN. (Arq Bras Endocrinol Metab 2008; 52/4:581-588)

Pólipo fibrovascular gigante do esôfago: desafio diagnóstico

Fibrovascular polyps of the esophagus are rare benign tumors, with just over 100 cases reported in the literature. Are pedunculated, intraluminal, covered by normal mucosa and composed of vascular, adipose and fibrous tissue3. It originates usually on the proximal third of the esophagus and can reach large dimensions. The symptoms only appear when the polyp becomes large. There are reports of sudden death from asphyxiation after regurgitation of the tumor11. The incidence is higher in men, 50 to 60 years3,10. In view of the debilitating symptoms and the risk, resection is indicated and usually performed by cervical esophagotomy3. Endoscopic surgery is reserved for cases of small polyps.

Vaginoplasty With Full-thickness Mesh Skin Graft for Vaginal Agenesis

OBJECTIVE To present a novel technique in reconstructive urology for congenital vaginal agenesis using a full-thickness mesh skin graft and to evaluate the functional capacity for maintenance of satisfactory intercourse. METHODS From January 2009 to August 2015, seven patients diagnosed with vaginal agenesis underwent vaginoplasty using a full-thickness mesh graft from lower abdominal skin. Herein, the authors describe the technique and initial results in adult patients. RESULTS The mean hospital stay was 8 days. There were no major complications or need for blood transfusions. The most relevant postoperative result was the functionality of the neovagina and satisfactory donor site results. At 6-month follow-up, all patients reported satisfactory sexual intercourse. The average depth of the vagina was 11.3 cm. There were no significant complications at donor site or at neovagina that needed surgical intervention. CONCLUSION We obtained positive functional results with minimal donor site morbidity by performing vaginal reconstruction using a full-thickness mesh skin graft.

Child non-ischemic priapism, a conservative approach: Case report and updated review

Non-ischemic priapism in children is an uncommon entity usually related to blunt trauma in the perineal region and subsequent fistula formation into the corpus cavernosum. In this report we present the case of a 7-year-old boy who had undergone perineal trauma and developed non-ischemic priapism confirmed radiologically. He was treated by conservative measures along with ultrasonographic monitoring. We discuss the diagnostic approach, the radiologic findings and the mainly conservative management of this infrequent pathology.

Posterior Urethral Valves Disorder in Non-Twin Siblings: Case Report and Literature Review

Although a rare condition, Posterior Urethral Valves (PUVs) are the most common obstructive cause of chronic renal disease in children. In order to provide an early diagnosis, it is crucial to identify families with a high risk of developing this disorder. Here, we report a rare case of non-twin siblings with PUV. The first sibling was diagnosed at 2 months of age, presenting with renal insufficiency and managed properly. Despite the brother’s history and general prenatal care, the second sibling presented with the same disorder, at 3 months of age, suffering from acute renal insufficiency, urinary tract infection and severe anemia, revealing even more important complications than the first sibling. We have reviewed the 12 cases of non-twin siblings previously reported in the literature, and noticed that in the majority of these families, late diagnosis was observed. Herein, we discuss aspects of management of the disorder, and highlight the importance of specific antenatal evaluation in boys with a positive family history.