Este trabalho constitui uma síntese e revisão dos principais resultados das pesquisas, com o objetivo de validar o grupo IB de Rudge. As gestantes deste grupo têm rastreamento positivo e diagnóstico negativo para o diabete gestacional, ou seja, apresentam resposta normal ao teste oral de tolerância à glicose (TTG100g). Apesar disso, as alterações nas glicemias ao longo do dia, confirmadas no perfil glicêmico (PG) caracterizam a hiperglicemia diária, fator responsável por risco materno e desfecho perinatal adverso. Estas gestantes são erroneamente incluídas na categoria de "pré-natal de baixo risco" e não estão sendo diagnosticadas e tratadas. Correspondem a 13,8% da população de gestantes rastreadas que, somados aos 7,0% das gestações complicadas por diabete, aumentam a ocorrência de distúrbios hiperglicêmicos na gestação para cerca de 20,0%. Tem índice de mortalidade perinatal de 41‰, semelhante ao de gestantes diabéticas e 10 vezes maior que o de não diabéticas; suas placentas apresentam alterações morfológicas e funcionais diferenciadas dos grupos de gestantes não diabéticas e diabéticas, indicativas de ajuste para manutenção da atividade funcional, facilitando a passagem de glicose para o feto e explicando a macrossomia fetal (53,8% das gestantes não tratadas). O risco materno para hipertensão, obesidade e hiperglicemia é elevado e parece reproduzir modelo da síndrome metabólica, favorecendo risco potencial para diabete no futuro; 10 anos após a gravidez-índice, o diabete clínico tipo 2 foi confirmado em 16,7% das mulheres do grupo IB. Os autores propõem o desenvolvimento de projetos multicêntricos, para identificar biomarcadores, de múltiplos enfoques, específicos das gestantes do grupo IB de Rudge e estabelecer protocolos para o diagnóstico dos distúrbios hiperglicêmicos da gestação, padronizando a associação TTG100g + PG, conduta que poderá causar impacto na morbimortalidade perinatal das gestações complicadas por hiperglicemia diária.

A prospective, randomized, controlled study was performed to determine the haematological and biochemical changes and clinical safety of postoperative autotransfusion (Solcotrans Orthopedic Plus system) in patients undergoing spinal surgery. Fifty patients were studied and were randomly allocated to Control (n = 25) and Solcotrans (n = 25) groups. Both groups had their postoperatively drained blood collected into the Solcotrans reservoir but only the Solcotrans group had this salvaged blood considered for reinfusion. After a 5-h postoperative collection period, analysis of the shed blood showed a haematocrit of 0.26 +/- 0.11, few platelets (80 +/- 63 10g.l-1), a fibrinogen level of less than 0.1 g.l-1 and a high level of D-dimers. The salvaged blood did not clot and aerobic and anaerobic culture produced no growth. The volume of blood collected was greater than 200 ml in 21 patients in the Solcotrans group who were autotransfused (384 +/- 101 ml, range 200-600 ml), and in 16 patients in the Control group. Within 15 min following completion of reinfusion of the salvaged blood there was a significant, but moderate decrease in platelet count (181 +/- 74 vs 223 +/- 90 10g.l-1, P < 0.001) and fibrinogen concentrations (2.1 +/- 0.8 vs 2.3 +/- 0.9 g.l-1, P < 0.02), and an increase in circulating D-dimers (P < 0.001) and plasma free haemoglobin concentrations (236 +/- 155 vs 82 +/- 79 mg.l-1, P < 0.001). Prothrombin time (PT) and activated partial thromboplastin time (APTT) did not increase, and potassium concentrations were not significantly affected.(ABSTRACT TRUNCATED AT 250 WORDS)

Context: Intrauterine growth retard (IUGR) continues to be a significant perinatology problem at the end of this century. The nature of the etiologic agent, the time when the attack occurred during pregnancy and its duration affect the type of IUGR. Objective: To study the evolution of fetal pancreas and placenta between the 18th and 21st day of pregnancy in rats submitted to maternal protein-calorie restriction. Design: Randomized controlled trial on laboratory animal. Sample: Forty-one normoglycemic pregnant Wistar rats. Intervention: Rats were divided into six experimental groups according to their access to food and date of cesarean section (18th or 21st day): control with free access to food; diet restricted to 25% introduced on 1st day of pregnancy; and diet restricted to 25% after the 3rd day of pregnancy. Main measurements: Newborn weight, placenta weight, histopathological study (morphological histochemistry) Results: Maternal protein-calorie malnutrition caused intrauterine growth retard (IUGR) after the 18th day of pregnancy. Dietary restriction did not interfere with the morphology of the fetal pancreas and the immunohistochemical study of the placenta showed that glycogen stores were decreased between the 18th and 21st day in the control group and in a diet restricted to 25% from the first day of pregnancy. Dietary restriction after the 3rd day of pregnancy led to low placental glycogen concentrations on the 18th day and disappearance on the 21st day. Conclusion:The pathophysiology of IUGR due to maternal protein-calorie restriction in rats is related to lower placental weight and low placental glycogen stores.

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