[Prevalence of metabolic syndrome (MS) in patients with type 1 diabetes (DM1)]. / Prevalencia del síndrome metabólico (SM) en pacientes con diabetes mellitus de tipo 1 (DM1).

BACKGROUND: Double diabetes is the association between type 1 diabetes mellitus (DM1) and metabolic syndrome (MS). The prevalence of hypertension, dyslipidemia, central obesity and macrovascular complications has increased in DM1 patients, regardless glycemic control. OBJECTIVE: To determine the prevalence of MS in patients with DM1. METHODS: We performed a descriptive cross-sectional study of clinical characteristics of DM1 patients. Biochemical and anthropometric parameters were determined and the presence of hypertension, dyslipidemia and central obesity were assessed. MS was defined according to American Heart Association/National Heart, Lung and Blood Institute (AHA/NHLBI) and National Cholesterol Education Program: Adult Treatment Panel III (NCEP:ATPIII) criteria. RESULTS: For this study 130 patients were evaluated (66% women) with a median age of 29.5 years (interquartile range [RI]: 22-36) and disease evolution of 12 years (RI: 7-17). 47% had dyslipidemia, 23% hypoalphalipoproteinemia, 11% hypertrigliceridemia and 13% both pathologies. Additionally 64% had high level of low-density lipoprotein cholesterol (C-LDL) and 21% had hypertension. According to AHA/NHLBI criteria, 37.5% (with three parameters) and 14% (more than three parameters) of patients were estimated to have MS. On the other hand, using NCEP:ATPIII criteria 25% (three parameters) and 11.5% (more than three parameters) had MS. Patients with DM1 and MS were older, heavier and had greater body mass index (BMI) and waist circumference. CONCLUSION: The presence of MS in patients with DM1 is evident in our study. There are no differences in glycosylated hemoglobin or insulin doses between groups with and without MS.

[Sellar remodeling: a surgical option for primary empty sella syndrome]. / Remodelación selar: una opción quirúrgica para el síndrome de la silla turca vacía primaria.

BACKGROUND: The empty sella is an entity that only rarely presents signs and symptoms. When noted, visual field deficits are an indication for surgical management. MATERIAL AND METHODS: We studied twenty patients with primary empty sella and visual field deficits surgically treated with a technique termed by us as "sellar remodeling." We treated 19 females and 1 male. Aside from visual deficits, all participants reported headache. We reported an increase in prolactin serum level in three cases. Patients with an increase in cerebrospinal fluid pressure were excluded. The surgical procedure involved placing through a transsphenoidal route an autologus graft formed by fat, aponeurosis and two bone lamina, with precise dimensions according to each patient's sella turcica. RESULTS: After surgery, visual deficits improved in 18 patients and headache in 17. Two patients displayed normal prolactin levels. No serious complications were reported during surgery. CONCLUSIONS: Sellar remodeling is a precise, simple, safe and inexpensive technique that significantly improves symptoms such as visual deficits and headache observed in primary empty sella syndrome.

Remodelación selar: una opción quirúrgica para el síndrome de la silla turca vacía primaria / Sellar remodeling: a surgical option for primary empty sella syndrome

Antecedentes: La silla turca vacía es una entidad que sólo en raras ocasiones presenta signos y síntomas, dentro de los cuales la afección en el campo visual es una indicación para el manejo quirúrgico. Materiales y Metodos: Se analizaron 20 pacientes con silla turca vacía primaria y alteraciones en los campos visuales, que fueron manejados quirúrgicamente con una técnica que denominamos remodelación selar. Fueron 19 mujeres y un hombre; todos ellos, además del déficit visual presentaban cefalea y tres casos elevación en el nivel sérico de prolactina. Se excluyeron los que mostraron aumento en la presión del líquido cefalorraquídeo. El procedimiento quirúrgico consistió en la colocación, por vía transesfenoidal, de un injerto autólogo formado por grasa, aponeurosis y dos láminas de hueso, con dimensiones precisas de acuerdo al tamaño de la silla turca del paciente. Resultados: Con la cirugía se logró mejorar el déficit visual en 18 pacientes y la cefalea en 17; finalmente, dos de ellos normalizaron su nivel de prolactina. No se presentaron complicaciones serias. Conclusiones: La remodelación selar es una técnica precisa, sencilla, segura y barata que permite mejorar los síntomas del síndrome de la silla turca vacía primaria, en especial las alteraciones visuales y la cefalea.

BACKGROUND: The empty sella is an entity that only rarely presents signs and symptoms. When noted, visual field deficits are an indication for surgical management. MATERIAL AND METHODS: We studied twenty patients with primary empty sella and visual field deficits surgically treated with a technique termed by us as [quot ]sellar remodeling.[quot ] We treated 19 females and 1 male. Aside from visual deficits, all participants reported headache. We reported an increase in prolactin serum level in three cases. Patients with an increase in cerebrospinal fluid pressure were excluded. The surgical procedure involved placing through a transsphenoidal route an autologus graft formed by fat, aponeurosis and two bone lamina, with precise dimensions according to each patient's sella turcica. RESULTS: After surgery, visual deficits improved in 18 patients and headache in 17. Two patients displayed normal prolactin levels. No serious complications were reported during surgery. CONCLUSIONS: Sellar remodeling is a precise, simple, safe and inexpensive technique that significantly improves symptoms such as visual deficits and headache observed in primary empty sella syndrome.

[Familial Mediterranean fever in Mexico City. A 20-year follow-up]. / Fiebre mediterránea familiar en la Ciudad de México. Seguimiento durante 20 años.

Familial Mediterranean fever (MFF) is an autosomic recessive, inherited inflammatory disease principally seen in persons from the Mediterranean area. Clinical findings include fever, abdominal pain, and pleuritis. The most severe complication of MFF is renal amyloidosis, manifested as nephrotic syndrome, which evolves into chronic renal failure. In this study, we described clinical findings, evolution, and response to treatment in 52 patients diagnosed with MFF living in Mexico City in whom the most important clinical features were fever and abdominal pain. Differing from previous reported series of patients from the Mediterranean area, patient developed renal amyloidosis during the 20-year follow-up, which suggests that an environmental factor might have a significant influence in development of renal amyloidosis.

Emotional dysfunction associated with diabetes in Mexican adolescents and young adults with type-1 diabetes.

OBJECTIVE: To assess the emotional dysfunction associated with diabetes in Mexican young individuals with type-1 diabetes. MATERIAL AND METHODS: A cross-sectional survey was conducted to perform a complete clinical and psychosocial evaluation of 93 consecutive type-1 diabetes patients, and 14 to 30 years. RESULTS: Adolescents had higher scores of emotional dysfunction related to diabetes and a diminished knowledge in diabetes-related areas. A multivariate logistic regression model showed that an inadequate emotional response to diabetes (high problem areas in diabetes or PAID scores) was mainly associated with a poor glycemic control (OR = 2.9, 95% CI 0.9-9.7, p = 0.09). Apprehension about the future and the possibility of serious complications had the highest mean PAID score in all age groups. CONCLUSIONS: New strategies should be developed to improve the routine care and support of young individuals with type-1 diabetes.

Emotional dysfunction associated with diabetes in Mexican adolescents and young adults with type-1 diabetes

OBJECTIVE: To assess the emotional dysfunction associated with diabetes in Mexican young individuals with type-1 diabetes. MATERIAL AND METHODS: A cross-sectional survey was conducted to perform a complete clinical and psychosocial evaluation of 93 consecutive type-1 diabetes patients, aged 14 to 30 years. RESULTS: Adolescents had higher scores of emotional dysfunction related to diabetes and a diminished knowledge in diabetes-related areas. A multivariate logistic regression model showed that an inadequate emotional response to diabetes (high problem areas in diabetes or PAID scores) was mainly associated with a poor glycemic control (OR=2.9, 95 percent CI 0.9-9.7, p=0.09). Apprehension about the future and the possibility of serious complications had the highest mean PAID score in all age groups. CONCLUSIONS: New strategies should be developed to improve the routine care and support of young individuals with type-1 diabetes

[Primary hyperparathyroidism: a report of 67 cases. The experience of 5 years at the IMSS Centro Médico Nacional Siglo XXI Specialties Hospital]. / Hiperparatiroidismo primario, reporte de 67 casos. Experiencia de los últimos cinco años en el Hospital de Especialidades Centro Médico Nacional Siglo XXI.

INTRODUCTION: Primary hyperparathyroidism (PHPT) is a frequent disease. It is characterized by hypercalcemia and elevation of parathyroid hormone (PTH) levels. The incidence is variable, being more frequent in women (3:1) in the perimenopauseal period. In the last decades, diagnosis of asymptomatic PHPT has increased due to automatized calcium determinations. Duration of the disease and serum concentrations of calcium and PTH determine symptomatology. Surgery is the definitive treatment. It is important to assess surgical criteria in asymptomatic patients. Successful treatment of this disease depends on a highly specialized team of parathyroid surgeons. MATERIAL AND METHODS: We reviewed the clinical and biochemical background of patients subjected to parathyroidectomy from January 1998 to August 2003 in our medical center. We then analyzed clinical and laboratory data, final histopathologic diagnosis, and surgery outcome. RESULTS: Sixty seven patients were included, with an average age of 50 years (+/- 11.9), 15 men and 52 women. Greatest frequency of PHPT was observed in patients between 40 and 60 years of age. Average calcium value was 11.7 mg/dl (+/- 1.23) and that of PTH was 194.5 pg/ml (+/- 93). Histopathologic diagnosis was adenoma in 56 (83.58%), hyperplasia in 9 (13.43%), and carcinoma in 2 (2.9%) patients. Cure of the disease was achieved in 65 patients (97%). PHPT is a surgically curable disease; it is necessary to confirm diagnosis and decide on surgical treatment in accordance with established criteria even if the disease is asymptomatic.

Torsade de pointes en mixedema. Informe de un caso y revisión de la literatura / Torsade de pointes in myxedema. Report of a case and review of the literature

Se informa el caso de una mujer de 57 años de edad en quien se documentaron episodios de taquicardia ventricular incluyendo un episodio de torsade de pointes. La paciente era portadora de hipotiroidismo con mixedema secundario a Síndrome de Sheehan. Con el tratamiento sustitutivo de hormonas tiroideas no se presentó recurrencia de la arritmia y no hubo necesidad de administrar tratamiento antiarrítmico específico.

Fiebre mediterranea familiar en la ciudad de México / Familial mediterranean fever in Mexico city

Con el fin de difundir la existencia de pacientes con fiebre mediterránea familiar en la ciudad de México, se informan 47 casos en 9 familias, cuyas manifestaciones principales fueron: dolor abdominal en 46, fiebre en 45, dolor pleural en 10 y dolor articular en 8. Todas estas manifestaciones se presentaron en forma recurrente. Ninguno de los pacientes hasta la fecha tiene amiloidosis