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Objective To review external fixation used at preparation stage of primary and revision hip arthroplasty in complicated cases of rigid hip deformity to optimize patient outcomes. Material and methods Outcomes of 15 patients with considerable limb length discrepancy of lower limbs were reviewed. Shortening of 7 to 10 cm was observed in ten cases, and five had 5-to-7-cm discrepancy. All patients underwent two-staged surgical treatment including Ilizarov external fixation at the first stage followed by total hip replacement at the second phase. The external fixator was taken off at the end of distraction on the day of implant placement. The patients were followed up within 29 ± 17 months on average and maximum 57 months of two-staged surgical treatment. Results The Harris hip score measured 21 ± 9 prior to external fixation and 77 ± 13 after arthroplasty. The usage of external fixation allowed for limb length equalization in all the cases adapting soft tissues for the next arthroplasty surgery. No infection was reported. Four of fifteen patients developed dislocation of the prosthetic head (3 early and 1 delayed dislocations); two patients underwent closed reduction and another two had a revision arthroplasty to stabilize the joint. Conclusion External fixation devices used at preparation stage of primary and revision hip arthroplasty can be advocated for complicated rigid hip deformity to recover supportability of the leg, equalise limb length, adapt soft para-articular tissues, realign the centre of rotation and improve treatment outcomes.

The aim of this cross-sectional study was to determine the oral health condition in a Japanese population aged 40 to 79, in Bauru, Brazil as well as its association with the occurrence of diabetes mellitus and impaired glucose tolerance. It involved 530 subjects, from both sexes. All persons of first generation (Issei) and a random sample of one third of second generation (Nisei) were submitted to a home interview. A clinical examination, oral glucose tolerance test, and examination of oral health conditions took place at the Hospital of Rehabilitation of Craniofacial Anomaly - USP. The data were processed by Epi-Info program and 22.9% of the individuals presented diabetes mellitus (group I), 15.1% impaired glucose tolerance (group II), and 61.9% were considered normoglycemics (group III). The percentage of edentulous subjects was 45.9% for the total sample, and values of 58.4%, 46.7%, and 41.2% were observed for groups I, II, and III, respectively. Among the edentulous subjects, no one showed necessity of making a total prothesis. These data indicate that tooth loss showed significant association with the occurrence of diabetes mellitus, but there was no significant association with glucose intolerance.

Objective: Obesity, especially abdominal, has been associated with cardiovascular risk factors such as dyslipidemia, hypertension and diabetes mellitus (DM). The importance of these risk factors among Japanese-Brazilians was previously shown, although obesity is not a typical characteristic of Japanese migrants. In this study the prevalence of weight excess and central adiposity (CA) among Japanese-Brazilians and their association with metabolic disorders was evaluated., Methods: A sample of 530 1st and 2nd generation Japanese-Brazilians (aged 40 - 79 years) went through anthropometric and blood pressure measurements, lipid profile and oral glucose tolerance tests. The prevalence rate (point and confidence interval) of overweight was calculated using a cut-off value of >26.4 kg/m2. CA diagnosis was based on waist-to-hip circumference ratio (WHR): greater-than-or-equal 0.85 and 0.95 in women and men, respectively., Results: The prevalence of weight excess was 22.4% (CI 95% 20.6 - 28.1), and CA was 67.0% (95% CI 63.1 - 70.9). In addition to higher prevalence of DM, hypertension and dyslipidemia, stratifying by BMI and WHR, people with weight excess and CA revealed a poorer metabolic profile: blood pressure levels were significantly higher among those with weight excess with or without CA; CA individuals had higher glucose, triglycerides, total and LDL cholesterol, and lower HDL than those without weight excess or CA; fasting insulinemia was significantly higher among subjects with weight excess (with or without CA) than among those without weight excess or CA., Conclusion: Comparing subgroups with and without CA supports the hypothesis that abdominal fat accumulation represents a risk factor for insulin resistance-related diseases, even among Japanese descendants. The increased prevalence of metabolic syndrome among Japanese migrants could be attributed to visceral fat deposition, which has been implicated in the genesis of insulin resistance.

We evaluated dietary habits as risk factor for glucose intolerance in a high risk population of Japanese-Brazilians enrolled in a study on the prevalence of diabetes (DM). Based on oral glucose tolerance test and WHO criteria, 331 had normal tolerance (NGT), 88 impaired tolerance (IGT) and 83 had type 2 DM (51 self-reported, 32 newly diagnosed diabetics). Clinical, laboratory and dietary data, assessed by food frequency questionnaire (FFQ), were compared between the NGT group and another composed of IGT and newly diagnosed DM (disturbed glucose tolerance or DGT group). Associations of total energy intake and nutrient intakes with glucose intolerance were analyzed by logistic regression. Also, subjects with NGT and DGT entered into separate models of multiple linear regression including BMI as the dependent variable, and total energy intake or each nutrient as independent variables. DGT group showed higher waist-to-hip ratio, blood pressure, plasma glucose and insulin levels and worse lipid profile. Total energy intake, macronutrients, fibers, alcohol and saturated fat intakes did not differ between groups; DGT was not associated with any nutrient intake in multivariate analyses. BMI of the subjects with DGT but not with NGT was associated with protein and cholesterol intakes in linear regression analysis. Our findings did not support an association between nutritional factors and glucose intolerance even in subjects who are unaware of their DGT, using FFQ to reflect current habits. However, we suggest that protein and cholesterol intakes may be markers of increased BMI. Despite assuming that obesity and insulin resistance precedes DM, FFQ may not be useful in the assessment of unfavorable dietary patterns among subjects at risk for glucose intolerance, such as Japanese-Brazilians with elevated BMI.

We examined the data from 530 subjects enrolled in a survey on the prevalence of diabetes in a Japanese-Brazilian population aged 40-79 years. Past self-reported and current weight values were analysed. Student t test was used to compare anthropometric measures between subjects with and without disturbance of glucose tolerance (DGT), hypertension and dyslipidemia. Point and interval estimates of the weight at 20 years-, age- and sex-adjusted odds ratios (OR) were obtained by logistic regression analysis to evaluate the relationship between these diseases and the percent weight gain. Subjects with DGT, hypertension or dyslipidemia tended to have higher BMI during adulthood and to gain more weight in a shorter interval of time. Also, they presented higher waist-to-hip ratio and plasma glucose and worse lipid profile. OR were consistent with associations between chronic diseases and percent weight gain. Trend test of OR indicated that the risk of developing DGT alone or combined with hypertension and abdominal obesity increased 2% and 15% by percent unit of gained weight, respectively, as compared with those subjects with stable weight. Weight gain and the rate by which this occurs during lifetime may confer increased risk of chronic diseases. We suggested that preventive measures against obesity, i.e. the maintenance of healthy body weight lifelong, are necessary to minimize the occurrence of these diseases, also among migrant populations such as the Japanese-Brazilians.

Objective: As part of a study involving Japanese migrants, living in a developed city in the state of S. Paulo, Southeastern Brazil, a four-year experience of mortality among diabetic and non-diabetic subjects is described and their respective death rates are compared. In 1993, a cohort of 530 Japanese-Brazilians (236 issei or 1st generation and 294 nisei or 2nd generation) of both sexes, aged 40 from to 79 years old, were identified., Research Design and Method: At that time, 91 (17%) were classified as non-insulin-dependent diabetic subjects (NIDDM), 90 (17%) with impaired glucose tolerance (IGT) and 349 (66%) as normal, according to WHO criteria. In 1996, families were questioned with a view detecting the deaths which had occurred among the subjects previously studied. This information, in addition to that from death certificates was used to record the date and the causes of death. Mortality rates for all causes and for specific causes (circulatory and renal diseases) were obtained for the three groups of subjects, by glucose tolerance status. Proportional hazard regression models were used to compare the mortality rates, adjusted for several covariables (gender, age, generation, hypertension, dyslipidemia, obesity and serum creatinine)., Results and Conclusions: Crude mortality rate ratios for all causes and specific causes, for NIDDM, and normal subjects were 2.95 (95% CI: 1.10-7.62) and 4.57 (95% CI: 1.31-16.48), respectively. No difference was observed between the crude mortality rate ratio for IGT and normal subjects. After simultaneous adjustments for the covariates, higher mortality rates for specific causes were observed among NIDDM than in the normal subjects (mortality rates ratio: 3.86; 95% CI: 1.11-13.38). These results in Japanese-Brazilians are consistent with previous reports of increased mortality in other diabetic subjects, thus confirming the adverse effect of this metabolic disturbance on mortality among diabetic subjects.

Japanese individuals living outside Japan are more susceptible to chronic diseases included in the insulin resistance syndrome. Hyperinsulinemia and hypertension are associated, but large studies adjusting for confounders are still required. The present evaluated if insulin (I) or proinsulin (PI) was associated with hypertension after adjustment for other risk factors, in first (n=238) and second (n=292) generation Japanese-Brazilians, aged 40 to 79 years, living in a developed city in Brazil. Blood pressure (BP) was measured by random-zero sphygmomanometry. People with mean systolic/diastolic BP >140/90 mm Hg or taking antihypertensive drugs were considered hypertensive. Diagnosis of diabetes was based on results of an oral glucose tolerance test using WHO criteria. I and PI after fasting and 2 hours after glucose load were determined by specific immunofluorimetric assays. The first generation was older than the second (65.6+/-9.2 versus 53.6+/-8.4 years, P<.01) and male/female ratios were 1.14 and 0.87, respectively. The age-adjusted prevalence of hypertension was 29.2% with no difference between sexes or generations. Higher body mass index (25.2+/-4.3 versus 23.8+/-3.3 kg/m2), waist-to-hip ratio (0.939+/-0.067 versus 0.919+/-0.073), plasma glucose (6.3+/-2.3 versus 5.6+/-1.8 mmol/L), cholesterol (5.74+/-1.19 versus 5.48+/-1.08 mmol/L), and creatinine (74+/-26 versus 83+/-36 micromol/L) were found among the hypertensives (P<.05). Univariate analyses showed associations of obesity, diabetes, and dyslipidemia with hypertension. Logistic regression analyses demonstrated that 2-hour I (OR, 1.22; 95% CI, 1.02 to 1.46) and fasting PI (OR, 1.14; 95% CI, 1.00 to 1.31) remained significantly associated with hypertension, after adjustment for age, sex, generation, family history of hypertension, smoking habits, waist-to-hip ratio, serum creatinine, glucose intolerance, and dyslipidemia. Japanese-Brazilians have a higher prevalence of hypertension than the general population in Brazil. High levels of 2-hour I, seen in hypertensives, may be interpreted as independent risk factors for hypertension in this population. Our findings suggest that fasting PI should be useful, in addition to insulin, to assess risk factors for hypertension in epidemiological studies.

The immigration of Japanese people to Brazil began in 1908 with two major waves, from 1925 to 1940 and from 1952 to the 1960s. Brazil has the largest population (about 1,288,000) of Japanese origin outside Japan with varying age groups. A mortality study revealed that diabetes as an underlying cause of death was higher in the first-generation Japanese than in Japan (3.4 vs. 1.9 per 100,000 for men, and 7.2 vs. 1.9 for women). The self-reported prevalences of known diabetes in subjects aged 40 years or older were obtained by questionnaires from three sources. In six Japanese cultural associations in Säo Paulo city, the prevalences were 9.7% and 6.9% for the first generation (mean age 61.5 years) and for the second generation (mean age 40.0 years), respectively. Age-adjusted prevalences, according to the Brazilian population in the 1980 national census, were 6.9% and 8.1% for the first and second generations. According to a study carried out as a part of a socioeconomic census of the Japanese population in Brazil, the prevalences of diabetes were 7.4% and 5.2%, and the age-adjusted prevalences were 5.3% and 5.8% in the first and second generations, respectively. Another study carried out for employees of a bank, owned by Japanese-Brazilian community members, revealed crude prevalences of diabetes in the first and second generations of 7.1% and 4.2%, and age-adjusted prevalences of 7.3% and 8.2%, respectively. These data indicate an increased prevalence of diabetes in this population compared to Japan, suggesting the importance of environmental factors in the pathogenesis of diabetes.

The vitamin A concentration in liver samples taken at autopsy from the central portion of the right lobe of 57 infants 0-1 year old was determined by a dual spectrophotometric and colorimetric assay. Death was due to respiratory disease (30%), complications of premature birth (16%), infections (14%), hemorrhage (14%), pneumonia (10%), cerebral edema (7%), and miscellaneous causes (9%). Gross malnutrition was noted in only 2 of these children. The median vitamin A concentration was 61 micrograms of retinol/g liver, with a range of 6-293 micrograms/g. The percent distribution of liver vitamin A levels in micrograms/g was: less than 5 (0%); 5-10 (7%); 10-20 (5%); 20-40 (16%); 40-80 (42%); 80-120 (14%); greater than 120 (16%). The mean liver level in 9 stillborn full-term infants (60 micrograms/g) was markedly lower than in 7 stillborn premature infants (125 micrograms/g). The median value for 22 infants from indigent families (54 micrograms/g) was lower than that of 35 infants from non-indigent families (65 micrograms/g). By applying the criteria that liver reserves of vitamin A less than or equal to 5 micrograms retinol/g of liver indicate a high risk of vitamin A deficiency and those less than 20 micrograms retinol/g of liver denote an inadequate reserve, no infant was at high risk but 12% had insufficient reserves.

The histopathological features of four cases of placental involvement in schistosomiasis mansoni are described. One of the pregnancies resulted in a normal newborn, the other three in stillbirths. Adult worms were found in the intervillous space in one case and in the decidual vessels in another. Eggs were found in the placenta in all cases, in the intervillous space, within villi, or in the decidua. There was no evidence of fetal infection. The differential diagnosis with other forms of granulomatous placentitis is discussed.