Ten patients with progressive systemic sclerosis (PSS) and esophageal symptoms (group 1) and 10 control subjects were studied. Esophageal electromanometry using the intermittent pull-through technique and catheter perfusion with distilled water were performed in all patients and individuals. The variables studied were pressure amplitude in the lower esophageal sphincter (LES) (mmHg) and deglutition wave amplitude (mmHg at 5, 10 and 15 cm above LES). In PSS patients, the average LES pressure was 18.5 +/- 4.6 mmHg, and in control subjects it was 27 +/- 6.5 mmHg (p < 0.01). Deglutition wave amplitude at 5, 10 and 15 cm above LES was 13.2 +/- 7.5 mmHg, 12 +/- 3.7 mmHg and 15 +/- 3.3 mmHg, respectively, in PSS patients. In control subjects, it was 67.6 +/- 12.5 mmHg, 58.6 +/- 20.9 mmHg and 52.4 +/- 21.4 mmHg (p < 0.001). In PSS patients, the pressure amplitude in LES and in the body of the esophagus was lower than in control subjects. In PSS patients, esophageal manometry showed the absence of normal peristalsis.

Foram examinadas 378 crianças de um grupo escolar da Capital do Estado de São Paulo, com a finalidade de verificar se a prevalência de cárie dental em crianças de côr branca é maior do que em crianças de côr não branca. Após a análise estatística dos dados, utilizando o teste U, de Mann-Whitney, não paramétrico, concluiu-se que os brancos apresentam uma prevalência de cárie estatìsticamente maior, nas idades de 8, 10 e 12 anos, a um nível de significância de 5%.Recebido para publicação em 6-7-1967. -INTRODUÇÃOUma das grandes preocupações dos pesquisadores em relação à epidemiologia da cárie dental, é saber quais são as variáveis que podem alterar, para mais, ou para menos, sua prevalência. Até o presente momento, está suficientemente estabelecido que há duas grandes variáveis que agem nêste sentido: Açúcar e Flúor. Segundo o esquema de EASLICK 2 (1952), os açúcares refinados consttiuem o "substrato de glúcides fermentáveis" que leva ao processo de descalcificação do esmalte. Por sua vez, o flúor atua melhorando a "estrutura solúvel aos ácidos" e inibindo o "sistema enzimático". O mesmo autor considera ainda outros três fatôres essenciais que são -presença de microorganismos acidófilos e acidógenos, placa bacteriana dental e suscetibilidade do paciente, êste último, ìntimamente relacionado com nosso trabalho.Com respeito à suscetibilidade, já existem vários estudos quanto a povos diferentes, sexo, côr, condições sócio-econô-micas, etc., comprovando-se que há indivíduos que possuem uma imunidade que os protege. KLEIN 3 (1946) apresenta observações de famílias humanas cujos membros apresentam muito pouca, ou nenhuma cárie dental, durante algumas gerações. Em relação a raças, temos que tomar cuidado quanto ao meio ambiente

The connective tissue diseases are usual causes of many gastrointestinal complaints. The use of an interview plus predefined questionnaire seems a very effective way to identify and characterize symptoms and is even sometimes able to uncover features unknown before. Finally, the lack of studies, specially updated studies, did not allow more comprehensive comparisons.

Rheumatoid cachexia can be defined as an involuntary loss of body cell mass, which predominates in skeletal muscle, but is also observed in the viscera and immune system. It occurs with little or no weight loss in the presence of stable or increased fat mass. The etiology is likely multifactorial, and involves excessive inflammatory cytokine production, namely excess tumor necrosis factor-α and interleukin-1β production, reduced peripheral insulin action, and low habitual physical activity. Cachexia occurs in active rheumatoid arthritis and even in the presence of disease control. In this article, we discuss the pathogenesis of rheumatoid cachexia, its clinical implications and potential therapies.

the Technological and Scientific Development (CNPq), and the Coordination for the Improvement of Higher Education Personnel (CAPES -code 001) Conflict of interest: None declared Background:Rheumatoid arthritis (RA) can cause extra-articular manifestations, and the myocardium can be a target. This study aimed to describe structural and functional cardiac echocardiographic variables in RA patients and to evaluate whether vitamin D (VD) levels and inflammation markers, evaluated by Disease Activity Score-28 for Rheumatoid Arthritis with C-reactive protein (DAS28-CRP), are associated with cardiac remodeling (CR) in this population. Material/Methods:This prospective observational study evaluated 90 patients with RA in Botucatu University Hospital wards from 2014 to 2017. Clinical data were recorded, including demographic information, comorbidities, length of disease, and treatment type. Serum VD and C-reactive protein levels were measured, and the DAS28-CRP was calculated. A transthoracic echocardiography study was performed. The outcome evaluated was CR. This parameter was assessed by left ventricular geometric patterns and left atrium diameter. Results:We evaluated 90 RA patients. The mean age was 52.9±10.8 years, and 17.8% were male. The length of the disease was 96 (60-180) months. Serum VD levels were 30.7±10.4 ng/mL and the DAS28 was 2.7±0.9. Regarding the CR parameters, 56.7% had altered left ventricular geometric patterns and 25.8% had enlargement of left atrium diameter. Even in multivariate analysis, the left ventricular geometric patterns were not associated with the VD levels and the inflammation marker used. However, sufficient VD levels protect from left atrium enlargement (OR: 0.905; IC 95%: 0.843-0.973; P=0.007). Conclusions:Low serum vitamin D values, but not inflammation, are associated with CR in patients with RA.

Chronic inflammation presented in rheumatoid arthritis (RA) is associated with systemic manifestations, that include micronutrient deficiency, changes in body composition and cardiac morphofunctional alterations. The aim of this study is to evaluate the association of serum vitramin D and body composition with cardiac geometric pattern in patients with RA. Methods: 30 patients with RA were submitted to clinical, nutritional and biochemical evaluation. Bioimpedance analysis and dual‐energy X‐ray absorptiometry (DEXA) was performed to evaluate body composition. Transthoracic dopller‐ echocardiography was performed to evaluate left ventricle mass and relative wall thickness (RWT) in order to find cardiac geometry patterns. Patients were divided in Normal or abnormal pattern (concentric remodeling or concentric hypertrophy.) Results: The mean age was 53±9 years; 70% were woman, 43% presented with hypertension. All patients have been treated with methotrexate and a biological agent and presented with Disease activity Score (DAS28) 2,7±1,2. Serum vitamin D (ng/mL) was 30± 10,Body composition showed: BMI (kg/m2 ) 26±6, abdominal circumference (cm) 96±12, hand grip (kgf) 19±4,6 ; fat mass evaluated by DEXA (%) 33,8 ± 9,5 and by bioimpedance (%) 34,7±8,3; phase angle 6,6±0,6. Normal Cardiac geometric pattern was observed in 45%, concentric remodeling in 31% and concentric hypertrophy in 24%. Multiple logistic regression showed that hypertension and phase angle explain abnormalities in geometric pattern, even when adjusted by age, gender and hypertension. Vitamin D correlated with RWT, however it is not associated with geometric pattern. Conclusion: phase angle may be a potential marker of cardiac geometric pattern in patients with RA. Grant Funding Source: FAPESP: Fundação de Amparo à Pesquisa do Estado de São Paulo

Las lesiones metastásicas en pene de carcinoma prostático son infrecuentes, menores al 0.3%. Los casos comunicados en la literatura son pocos. Esta manifestación suele ser de mal pronóstico y un signo de enfermedad avanzada con una supervivencia menor de un año. Presentamos el caso de un paciente en quien se constató un nódulo en el pene de progreso acelerado. Se comprobó metástasis de próstata y falleció 8 meses después de la penectomía total.

No abstract