Browsing by Author "Ruas, A"
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- Diabetes Mellitus após transplante renalPublication . Ruas, L; Bastos, M; Alves, R; Rodrigues, D; Barros, L; Mota, A; Carvalheiro, M; Ruas, A; Furtado, AL
- Estudo comparativo, aleatorizado, em dupla ocultação, de orlistat versus placebo , de eficácia e segurança, em doentes obesos com hipercolesterolemia ligiera a moderadaPublication . Castro, JJ; Dias, T; Chambel, P; Carvalheiro, M; Correia, LG; Guerreiro, L; Marques, O; Medina, JL; Nobre, E; Nunes, JS; Pereira, MC; Polónia, J; Portugal, J; Raimundo, A; Ruas, A; Marques da Silva, P; Vasconcelos, C; Reis, JL; Galvão Teles, AINTRODUCTION: Obesity is a chronic disease and a serious health problem that leads to increased prevalence of diabetes, hypertension, dyslipidemia and gallbladder disease. OBJECTIVE: To evaluate the efficacy of orlistat for weight loss and improved lipid profile compared to placebo in obese patients with hypercholesterolemia, treated over a period of 6 months. METHODOLOGY: In a 6-month, multicenter (10 centers in Portugal), double-blind, parallel, placebo-controlled study, 166 patients, aged 18-65 years, body mass index (BMI) > or = 27 kg/m2, LDL cholesterol > 155 mg/dl, were randomized to a reduced calorie diet (600 kcal/day deficit) plus orlistat three times a day or placebo. Exclusion criteria included triglycerides > 400 mg/dl, severe cardiovascular disease, uncontrolled hypertension, type 1 or 2 diabetes under pharmacological treatment, and gastrointestinal or pancreatic disease. RESULTS: The mean difference in weight from baseline was 5.9% (5.6 kg) in the orlistat group vs. 2.3% (2.2 kg) in the placebo group. In the orlistat group 49% of patients achieved 5-10% weight loss and 8.8% achieved > 10%. The orlistat group showed a significant reduction in total and LDL cholesterol, with similar changes for HDL in both treatment groups. The frequency of gastrointestinal adverse events was slightly higher in the orlistat group than in the placebo group, leading to discontinuation in 7 patients. CONCLUSION: Treatment with orlistat plus a reduced calorie diet for 6 months achieved significant reductions in weight, BMI and lipid parameters.
- Hiperosmolaridade Diabética: análise retrospectiva de 60 casosPublication . Campos, MV; Bastos, M; Martins, T; Leitão, P; Lemos, MC; Carvalheiro, M; Ruas, AAIMS AND METHODS: Our aims were to determine the frequency of diabetic hyperosmolality (DH) in our Department, its causes, therapeutic implications and evolution. A five-years retrospective study was performed in 60 patients regarding age, sex, type and duration of diabetes mellitus (DM), previous antidiabetic therapy, underlying diseases, biochemical data, precipitating factors, therapeutic management and outcome. RESULTS: The hyperosmolar coma was responsible for 90% of the metabolic comas and for 3% of the diabetic patients. The median age of the cohort was 54.6 +/- 9.4 years, being females 61.7% and males 38.3% In 40% no prior diagnosis of DM was made and in the remaining patients the previous antidiabetic therapy was unknown in 61%. Altered consciousness was found in 90%, being 28% in coma. The metabolic acidosis was detectable in 22.2%, the average glycaemia was 956 +/- 267 mg/dl and the osmolality was 349.4 +/- 34.3 mosm/l. The precipitating factors were: poor metabolic control in all patients (HbA1C 12.5 +/- 2.75%), infections in 76.6%, suspension of antidiabetic therapy in 10% and concomitant hyperglycaemic drugs in 6.6% of patients. The global mortality was 20%. CONCLUSIONS: The majority of the situations could be preventable if an attempted screening and diagnosis of DM was made and precipitating factors avoid or promptly treated.
- Hipofisite Auto-imune ou LinfocíticaPublication . Paiva, I; Gomes, L; Ribeiro, C; Carvalheiro, M; Ruas, AThis entity, due to the pituitary lymphoplasmacytic infiltrate, was described for the first time in 1962. The clinical suspicion relies on a rapidly progressing hypopituitarism, particularly with adrenal involvement, affecting women in the peripartum period or patients with previously recognized autoimmune disease. Diabetes insipidus is also often reported. A sellar mass is found in 80% of cases. The diagnosis is confirmed by histology, due to the absence of a specific serological test. The endocrine deficiencies are frequently definitive. Corticotherapy is usually effective in reducing neurological symptoms due to pituitary enlargement, and frequently allows to avoid surgery. The disease-related deaths were due to acute adrenal insufficiency or ineffectively treated hypopituitarism. We are reporting a clinical case of probable lymphocytic hypophysitis in the early post partum of a woman with depression and Graves disease. She has hyperprolactinemia and ACTH deficiency, without pituitary changes in the magnetic resonance imaging. She was treated and her depression and hyperthyroidism were relieved. Hyperprolactinemia recovered spontaneously but she still needs glucocorticoid substitution.
- Nefropatia diabética: protocolo de estudo pré-transplantação renalPublication . Baptista, C; Bastos, M; Paiva, S; Martins, T; Leitão, P; Lemos, MC; Alves, R; Bastos, C; Mota, A; Carvalheiro, M; Furtado, AL; Ruas, ABetween May 1990 and October 1998, 67 diabetic patients with end-stage renal disease, on dialysis, were submitted to a standardized protocol in order to assess the coexistence and degree of other diabetic and nondiabetic complications that could affect transplantation. Some of the results were analysed. Type 2 diabetic patients had more abnormal results on the lower limbs doppler ultrasound and on the lower limbs arteriography than type 1 (p < 0.05). Type 2 diabetic patients had more cardiovascular complications so the decision to transplant should be taken on a case by case basis.
- Radioterapia em tumores hipofisáriosPublication . Baptista, C; Paiva, I; Gomes, L; Gomes, F; Carvalheiro, M; Ruas, AThe aim of this study is to evaluate the use of conventional external radiotherapy in patients with pituitary adenomas. Between October 1970 and May 1998, 27 patients with pituitary adenoma were followed at the Department of Endocrinology and Diabetes of the Hospitais da Universidade de Coimbra. They received radiation therapy at Instituto Português de Oncologia. Seven of those tumors were classified as nonfunctioning adenomas, 17 as growth-hormone-secreting adenomas, 2 as prolactinomas and 1 as adrenocorticotropic adenoma. Twenty-six patients received radiation as adjuvant therapy after incomplete resection and one patient as primary treatment. The majority of these cases were treated using the parallel opposed-field technique with a total dose between 45 and 52 Gy. The patients were submitted, before and after radiotherapy, to a protocol in order to assess the efficacy of this treatment. Some of the results were analyzed. Reduction of tumor mass was achieved in 66.6% of nonfunctioning tumors and in 25% of the secreting ones. Reduction or stabilization of hormonal levels was achieved in 55% of the cases and normalization in 30%. The average duration of follow-up was 126.3 months. Complications observed: hypopituitarism, stroke (3 patients), cerebral edema (1 patient), memory loss (2 patients) and hearing loss (2 patients). None of the patients developed brain tumors
- Tiroidites agudasPublication . Paiva, S; Bastos, M; Gomes, L; Durão, A; Moreira, A; Barros, L; Rodrigues, D; Ruas, L; Ribeiro, C; Rodrigues, F; Paiva, I; Fagulha, A; Carrilho, F; Geraldes, E; Carvalheiro, M; Ruas, AWe review the pathophysiology, clinical features and therapy of acute thyroiditis. Four cases are reported stressing the role of fine needle aspiration for the diagnosis of this clinical entity.
- Transplantação pancreáticaPublication . Bastos, M; Campos, MV; Baptista, C; Alves, R; Bastos, C; Mota, A; Carvalheiro, M; Furtado, AL; Ruas, AA clinic case of simultaneous pancreas/kidney transplantation on a type 1 diabetic patient is described. A six years follow-up was made with both organs functionating and a good quality of live.Then the authors make a review of the available surgical techniques, indications and complications of this form of treatment. A comparison between the Portuguese and the International experience was discussed.
- Transplantação renal em doentes com diabetes mellitus tipo I e tipo IIPublication . Baptista, C; Bastos, M; Gomes, L; Macário, F; Ruas, L; Rodrigues, D; Alves, R; Gomes, H; Ferreira, C; Roseiro, A; Paiva, S; Barros, L; Carvalheiro, M; Mota, A; Furtado, AL; Ruas, AA total of 618 patients with end-stage renal disease received kidney transplants between 1980 and September 1996. Twenty eight of them were diabetics. Better results were achieved for type 1 diabetic patients than for type 2 (mortality: 5.9% vs 27.3%; functioning graft: 88.2% vs 72.7%). The morbility was also higher in those patients (infections: 81.8% vs 29.4%; vascular complications: 45.5% vs 17.6%). Actuarial patient and graft survival were lower for type 2 than for non diabetic patients. For type 1 diabetics the results are similar to those for non diabetics. Better results can probably be achieved by restricting the selection criteria. The decision to transplant or maintain on dialysis should be made on a case by case basis.