Efficacy of low-dose oral sulodexide in the management of diabetic nephropathy.

BACKGROUND: Diabetic nephropathy (DN) is the single greatest cause of end-stage renal disease (ESRD). Without specific interventions, microalbuminuria (incipient nephropathy) gradually progresses to macroalbuminuria (overt nephropathy) within 10-15 years in about 80% of type 1 and 30% of type 2 diabetic patients, and to ESRD within further 20 years in about 75% and 20%, respectively. A primary alteration in DN consists of decreased concentration of glycosaminoglycans (GAGs) in the glomerular extracellular matrix. This evidence has prompted interest in using exogenous GAGs and specifically sulodexide in DN treatment. PATIENTS AND METHODS: In this uncontrolled multicenter study, diabetic patients with albumin excretion rate (AER) >or=30 mg/24 hours were treated with oral sulodexide 50 mg/day for 6 months, while receiving concomitant medication as required. Two hundred thirty-seven patients (54% males and 46% females, mean age 55 years, mean diabetes duration 11 years) were evaluated; 89% had type 2 and 11% type 1 diabetes mellitus, 67% microalbuminuria and 33% macroalbuminuria. RESULTS: AER was significantly and progressively reduced during sulodexide treatment (p<0.0001): geometric mean after 3 and 6 months was 63.7% (95% confidence interval [95% CI], 59.3%-68.4%) and 42.7% (95% CI, 37.8%-48.2%) of baseline, respectively. The reduction was similar in type 1 and type 2 diabetes and was slightly greater in macroalbuminuric than in microalbuminuric patients. Blood pressure was slightly lowered, while fasting glucose and glycosylated hemoglobin were moderately reduced. Adverse effects were observed in 5.5% of patients, including gastrointestinal in 3.8%. CONCLUSIONS: Sulodexide therapy was shown to reduce AER in patients with DN.

[Predictive elements of malignancy of isolated thyroid nodules]. / Elements predictifs de malignite d'un nodule isole de la thyroïde.

The clinically revealed thyroid nodules are very frequent (3 to 5% of the general population), among them, fewer than 10% are malignant. The objective of this retrospective study type witness-case is to determinate the malignity predictive clinical and paraclinical elements for 45 patients presenting a thyroid malignant nodule and 45 others matched by age and sex presenting a thyroid isolated nodule. These patients were treated at the ORL ward of Charles Nicolle Hospital over a period of 10 years from 1989 to 1999. The average age of advent of malignant nodule is 43.2 + 14.4 years old with a clear female predominance (sex ratio = 4). The elements clearly linked to the hazard of thyroid cancer are loss of weight (p = 0.05; OR = 8.11), hard consistency of nodule (p = 0.002), the presence of cervical adenopathies (p = 0.05; OR = 4.22), vocal cords paralysis (p = 0.04), the presence of anemia (p = 0.01; OR = 5.7), a solid structure at sonography (p = 0.05) and the presence of a flux at doppler-sonography (p = 0.02). Personal antecedents of non malignant thyroid pathology, the nodule location and size and hypoechogenic features have not been clearly associated with the hazards of thyroid cancer.