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J Barbosa

Publications and source records attributed to J Barbosa.

215 records · Page 12Linked to original sources
PubMedDate not supplied

Severe hypoglycemia during maximized insulin treatment of diabetes in a randomized clinical trial.

Our experience with hypoglycemia during a randomized clinical trial testing the hypothesis of a causal relationship between hyperglycemia and diabetic complications is described. Patients under maximized control experienced hypoglycemia much more often than patients under standard control. There were five episodes of serious hypoglycemia, none of them on pumps, in the former group, but none in the latter. Lack of compliance (or overcompliance) with certain aspects of intensive treatment increases the danger of grave hypoglycemia and should be part of exclusion criteria when considering maximized control.

Adult↗
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Diabetes Mellitus, Type 1↗
PubMedDate not supplied

[Hypospadias. Review of a caseload and of the various techniques used--279 cases].

A review was made of 279 children with Hypospadias treated in Pediatric Surgery Department. Hypospadias was classified in accordance with existence of chordee and position of urethral meatus. Indications and the results are discussed according to Hypospadias type and surgical procedure performed over the years. Glanular Hypospadias (144 cases) were treated as follows: 117 by meatotomy or advancement meatoplasty and postectomy with 1.09 mean interventions per patient (M I/P). 24 by MAGPI procedure with 1,12 M I/P and 3 by other procedures. Distal penil Hypospadias without chordee (87 cases), 23 were treated by Denis Browne Crawford (DBC) procedure with 2,82 M I/P, 62 by Van Der Meulen procedure with 1,48 M I/P and 2 by other procedures. Hypospadias with chordee, penile and perineal (48 cases) 35 had chordee release followed by DBC procedure with 4,0 M I/P, 7 by Duckett procedure with 2,0 M I/P and 6 by other procedures. The present tendency towards the use of single stage procedures, namely MAGPI, Van Der Meulen and Duckett is analysed. Its advantages for patients and institutions--lower M I/P, decrease of hospitalization period, repair completed earlier in life and reduced emotional damage--are balanced with aesthetical results and frequency of complications.

Child, Preschool↗
PubMedDate not supplied

Effect of glycemic control on early diabetic renal lesions. A 5-year randomized controlled clinical trial of insulin-dependent diabetic kidney transplant recipients.

OBJECTIVE: To determine whether optimized glycemic control in type I diabetic recipients of renal allografts will prevent or delay diabetic renal lesions in the allograft. DESIGN: Prospective, controlled, and randomized trial of glycemic control in an inception cohort of type I diabetic renal allograft recipients. The experimental group underwent maximized glycemic control, and the standard group was treated in the same way as other patients in the transplant clinic. Patients underwent baseline (before transplant) and 5-year posttransplant allograft biopsies. SETTING: University of Minnesota Hospital and Clinic and the Clinical Research Center and Hennepin County Medical Center, Minneapolis. PATIENTS: Type I diabetics with terminal diabetic renal failure undergoing renal transplantation. Forty-eight patients randomized to maximized or standard control completed the trial. INTERVENTION: Subcutaneous insulin given several times a day or continuously (maximized group) and once or twice each day (standard group) was used throughout the trial. A significant difference for hemoglobin A1 level was maintained (mean +/- SD: standard, 0.117 +/- 0.013; maximized, 0.096 +/- 0.016; P < 0.001). MAIN OUTCOME: The primary end point of this trial was the difference between the groups in renal glomerular mesangial expansion as determined by electron microscopy. RESULTS: There was a more than twofold increase in the volume fraction of mesangial matrix per glomerulus in the standard group (mean +/- SD, 0.043 +/- 0.034) compared with the maximized group (0.019 +/- 0.038; P = .024). The threefold increase in arteriolar hyalinosis, the greater widening of the glomerular basement membrane, and increase of volume fraction of the total mesangium in the patients who received standard treatment all approached significance (P = .10 or less). The incidence of severe hypoglycemic episodes was greater in the maximized group (1.7 per patient per year) than in the standard treatment group (< 0.1 per patient per year; P < .001). CONCLUSIONS: This trial indicates a causal relationship between hyperglycemia and an important lesion of diabetic nephropathy, mesangial matrix expansion, in renal allografts transplanted into diabetic recipients. In addition, the results with other lesions central to the development of diabetic nephropathy support the major conclusion.

Adult↗
PubMedDate not supplied

Neurotransmitter control of growth hormone secretion in children after cranial radiation therapy.

Cranial radiation for childhood cancer can cause growth hormone deficiency (GHD), usually due to hypothalamic rather than pituitary dysfunction. To investigate whether this hypothalamic dysfunction is secondary to altered neurotransmitter input from other brain centers, we used neurotransmitter-excitatory substances to study the GH secretory response in 17 children who had received 12 to 60 Grey (Gy) to the cranium and 40 short children with normal endocrine function. As expected, the irradiated children had decreased mean GH secretion in response to insulin-induced hypoglycemia and arginine infusion, and decreased mean 24 hour GH concentrations, compared to the control group. In contrast, the two groups had similar GH secretory responses to GHRH stimulation and somatostatin suppression. Assessment of neurotransmitter pathways in the irradiated children revealed significantly lower mean peak GH concentrations in response to 5 of the 6 substances tested compared to control children: alpha-adrenergic stimulation (clonidine), beta-adrenergic blockade (propranolol), cholinergic stimulation, dopaminergic stimulation (L-dopa), and GABA-ergic stimulation (valproic acid). Results of serotonergic stimulation (L-tryptophan) were not statistically significant. Eleven patients who had abnormal GH secretion underwent 4 or more tests with neurotransmitter-stimulatory agents; 3 patients had peak GH concentrations of < 2.5 micrograms/l to all tests, whereas 4 patients had a peak GH concentration of > or = 7 micrograms/l to one or more tests but < 5 micrograms/l to one or more other tests. These observations suggest that radiation damage may sometimes spare growth hormone-releasing hormone (GHRH) and somatostatin secretion while affecting neurotransmitter pathways. We postulate that the hierarchy of sensitivity to radiation damage may be hypothalamic and extra-hypothalamic neurotransmitters > hypothalamic GHRH and/or somatostatin secretion > pituitary GH secretion.

Adolescent↗