Steno type 1 risk engine and preclinical atherosclerosis in Mediterranean individuals with type 1 diabetes.

BACKGROUND AND AIMS: Tools to detect type 1 diabetes (T1D) individuals at overt cardiovascular disease (CVD) risk are scarce. We aimed to assess the usefulness of the score 'Steno Type 1 Risk Engine' (Steno-Risk) to identify T1D patients with advanced carotid atherosclerosis. MATERIAL AND METHODS: T1D patients without CVD with at least one of the following were included: ≥40 years, diabetic nephropathy, or diabetes duration ≥10 years with ≥1 CVD risk factor. Intima-media thickness (IMT) and plaque presence (IMT ≥1.5 mm) were assessed by standardized B-mode ultrasonography. Steno-Risk was used to estimate 10-year risk (<10% low; 10%-20% moderate; ≥20% high risk). Associations between Steno-Risk and preclinical atherosclerosis were assessed after adjusting for other CVD risk factors. RESULTS: We evaluated 302 patients (55% men, age 47.8 ± 9.8 years, T1D duration 26.3 ± 9.3 years). The prevalence of carotid plaque and ≥2 plaques were 36.4% and 19.2%, respectively; without sex differences. Age (57.4 ± 7.4 vs 37.1 ± 6.2 years), T1D duration (31.3 ± 10.4 vs 21.5 ± 7.1 years), hypertension (52.3% vs 6.3%), nephropathy (25.6% vs 5.1%) and retinopathy (53.5% vs 32.9%) were higher in high-risk (n = 86) vs low-risk participants (n = 79; P < .001 for all). Preclinical atherosclerosis (IMT and plaque) increased in parallel with Steno-Risk (P < .001). In logistic regression analysis, both age ≥40 years and Steno-Risk ≥20% were associated with the presence of plaque (OR 4.22 [1.57-11.36] and 3.79 [1.61-6.80]; respectively), but only high Steno-Risk remained independently associated with ≥2 plaques (OR 3.31 [1.61-6.80]). CONCLUSION: Steno-Risk is independently associated with preclinical atherosclerosis. Further studies are needed to ascertain its usefulness in this high-risk population.

[Minor stroke in a patient with thrombocytopenia]. / Ictus menor en una paciente con trombocitopenia.

TITLE: Ictus menor en una paciente con trombocitopenia.

Thyrotoxic periodic paralysis: a case report and literature review.

We describe a 37-year-old man with a 4-month history of episodic muscular weakness, involving mainly lower-limbs. Hypokalemia was documented in one episode and managed with intravenous potassium chloride. Hyperthyroidism was diagnosed 4 months after onset of attacks because of mild symptoms. The patient was subsequently diagnosed as having thyrotoxic periodic paralysis associated with Graves' disease. Treatment with propranolol and methimazol was initiated and one year later he remains euthyroid and symptom free. Thyrotoxic periodic paralysis is a rare disorder, especially among Caucasians, but it should always be considered in patients with acute paralysis and hypokalemia, and thyroid function should be evaluated.

[Carotid thromboendarterectomy in the elderly patient: clinical characteristics in operated patients and short and middle term results]. / Tromboendarterectomía carotídea en el paciente anciano: características clínicas de los pacientes intervenidos y resultados a corto y medio plazo.

INTRODUCTION: Carotid thromboendarterectomy is the technique of choice for treating highgrade stenosis in patients less than 80 years of age, especially if they are symptomatic. Previous studies have also documented the persistence of the benefit of the procedure in elderly populations and, in addition, other treatments have not been demonstrated to be as effective or have been related to more frequent complications. This study describes the clinical characteristics, surgical results and outcome of patients older than 75 and 80 years old, treated by thromboendarterectomy in our center in comparison with a younger population. METHODS: Between the years 2000 to 2006, 86 patients were treated by thromboendarterectomy, 8 of them bilaterally. A retrospective study that described the data regarding clinical characteristics and outcome of the patients who had undergone endarterectomy was conducted and the different age groups were compared. RESULTS: Twenty-six patients older than 75 years old, 6 of whom were older than 80, were operated on. In the elderly patients, the fundamental risk factor was high blood pressure, there was a lower proportion of smokers and a higher proportion of contralateral severe stenosis or occlusion. Stenosis treated by surgery was more severe and had more aggressive characteristics. Comorbidity and anesthetic risk were the same as in younger patients. Surgical results, perioperative complication rates and short and long term outcome were similar in the different age groups (immediate morbidity-mortality due to transitory ischemic accident, stroke or death: 0% in older than 75 vs. 4.41% in those under 75). CONCLUSIONS: Our results support that age should not be considered a contraindication for the performance of a carotid thromboendarterectomy if there is a clear indication and acceptable morbidity and anesthetic risk, as in other population groups.

[Clinical, functional and quality of life differences in patients of different gender with essential tremor]. / Diferencias clínicas, funcionales y de calidad de vida en pacientes con temblor esencial de ambos sexos.

INTRODUCTION: Essential tremor (ET) is a chronic disease with important variability in its clinical manifestation, discapacity and quality of life (QoL) affectation. As previous reports have described differences in clinical manifestations of ET according to gender, this study proposes to check its existence in the Spanish population and to detect the presence of discapacity or alterations in QoL between different gender. METHODS: Patients with ET attended in the neurology clinic of a sanitary area were evaluated in a prospective consecutive way. Their clinical characteristics were recorded and discapacity and QoL were assessed through the Fahn and Tolosa scale for ET and the SF-36 health questionnaire. Comparisons between groups of both genders have been established. RESULTS: 104 patients with ET were evaluated (46 males and 58 females). Clinically there were differences concerning the localization and type of tremor. Although the intensity and the presence of discapacity were similar in both genders, women showed a lower QoL compared to men in the "physical role" dimension. CONCLUSIONS: There are differences in the clinical expression and in the affectation of QoL in patients with ET of different gender. Women had a lower score in the "physical role" dimension of QoL in comparison to their reference population, meaning lesser satisfaction with their performance capacity of their usual activities. QoL, thus, does not appear in this study as something only related with the degree of discapacity, but rather as having other determinant factors.

[Progressive myoclonic cerebellar ataxia as a manifestation of Creutzfeldt-Jakob disease]. / Ataxia cerebelosa mioclónica progresiva como manifestación de la enfermedad de Creutzfeldt-Jakob.

INTRODUCTION: Progressive myoclonic cerebellar ataxia is a clinical entity with an important spectrum of possible diagnoses that requires a complex and exhaustive differential diagnosis. CASE REPORT: A 53-year-old male patient with no relevant medical history who was admitted to hospital because of an unstable gait, together with mild bilateral dysymmetry and the progressive and insidious widening of the base of support. The patient's symptoms then became more pronounced and included myoclonus and a deterioration of the higher functions. The patient died four months after the onset of the symptoms. The explorations that were conducted included a pathological study of the brain, which confirmed the diagnosis of classical spongiform encephalopathy (Creutzfeldt-Jakob disease). CONCLUSIONS: Creutzfeldt-Jakob disease must be included in the differential diagnosis of progressive cerebellar ataxias.

[Pharmacological treatment of Korsakoff's psychosis: a review of the literature and experience in two cases]. / Tratamiento farmacológico de la psicosis de Korsakoff: revisión de la bibliografía y experiencia en dos casos.

INTRODUCTION: Korsakoff s psychosis (KP) is a relatively frequent pathological condition in our community that has been infradiagnosed. The most common cause is chronic alcohol consumption, although it can be brought about by other aetiologies accompanied by vitamin deficiencies. The lack of thiamine entails an alteration in the synthesis of neurotransmitters, which provides the neurochemical foundation for the specific cognitive impairment that defines the syndrome. AIMS: To evaluate the application of pharmacological treatments, in accordance with the neurochemical disorders described in the literature, and report our experience in two cases treated with anticholinesterases. CASE REPORTS: 1) Female aged 47, with a history of addiction to alcohol. Following Wernicke s encephalopathy, which improved with parenteral thiamine, she presented a memory disorder compatible with KP. After two months treatment with donepezil, a cognitive improvement was observed in the neuropsychological tests. 2) Male aged 77, who presented KP a month after being diagnosed and treated for a post encephalitic vasculitis caused be varicella zoster virus. His cognitive and functional condition improved after 3 months treatment with donepezil. DISCUSSION AND CONCLUSIONS: There are not enough studies in the literature with representative samples that consider the effects of thiamine or of other forms of treatment on cognitive impairment in KP. Noradrenaline, serotonin, glutamate and acetylcholine have been proposed in the pathogeny of the syndrome. Based on experiences gained in cholinergic disorders, two cases responded to treatment with donepezil. Effective treatment must be based on a combination of aetiological and pharmacological treatment, and cognitive rehabilitation.