[Gynecomastia and Leydig cell tumor]. / Ginecomastia y tumor de células de Leydig.

INTRODUCTION: Leydig cell tumors may generate estrogen production and gynecomastia. CASE PRESENTED: A 32-year man asked for medical advice due to gynecomastia. He had raised estrogen levels and diminished testosterone/estradiol index. A testicular echogram showed a nodular image in the right testis. Orchidectomy was performed and the diagnosis of a Leydig cell tumor was confirmed. The gynecomastia diminished, and estradiol remained lightly elevated, with little response to HCG. DISCUSSION: The more frequent hormonal manifestations of these tumors are high plasmatic and urinary estrogen levels, low serum testosterone, low testosterone/estradiol index, and FSH or LH low levels as well. The low response to HCG, the absence of metastasis and the good clinical evolution suggested the tumor was benign. Testicular echography is useful in the diagnosis of these tumors.

[Effect of enalapril on microalbuminuria and lipid profile of normotensive type I diabetes mellitus patients]. / Influencia de enalapril sobre la microalbuminuria y el perfil lipídico en pacientes con diabetes mellitus tipo I normotensos.

A longitudinal study for six months was conducted to demonstrate the influence of enalapril therapy on microalbuminuria in a group of patients with IDDM without arterial hypertension. An evaluation was also considered of its possible activity on other biochemical parameters, particularly plasma lipid levels. Thirty-four patients with IDDM were selected, with a mean age of 26.1 +/- 7.2 years and a mean clinical course of 11.8 +/- 5.6 years. Arterial blood pressure (ABP) was confirmed lower than 140/85 mmHg in all cases. Patients were administered 5 mg/day of enalapril and if a decrease in microalbuminuria higher than 25% was not achieved at the end of the first month of therapy, the dose was doubled (10 mg/day). No significant differences were found in ABP and in HbA1c throughout the study period. Albumin excretion in the initial period was 125.1 +/- 79.28 mg/24 h, at one month in the follow-up 47.6 +/- 44.1 mg/24 h, at three months 23.8 +/- 18.1 mg/24 h, and at the end of the 6th month 15.33 +/- 6.9 mg/24 h, all differences being significant. Renal function parameters and Na+ and K+ measurements remained unchanged for the follow-up period. No significant changes were detected for lipid and lipoprotein values for the length of the study. We conclude that therapy with enalapril in insulin-dependent diabetic patients without hypertension has an important effect on microalbuminuria during the first month of therapy; a stabilization in the normal range was reached in the third and sixth months of follow-up. No changes in arterial blood pressure nor in renal function were observed. Plasma lipid values were in the normal range throughout the study. Therefore, treatment for microalbuminuria with the ACEI assayed was efficient, in absence of arterial hypertension and irrespective of the metabolic control obtained. Future long-term studies are needed to evaluate the possible delay in the emergence of renal insufficiency.

[Course of cardiac autonomic neuropathy in diabetic patients++ depending on the degree of metabolic control]. / Evolución de la neuropatía autónoma cardíaca en diabéticos según el grado de control metabólico.

Thirty-one diabetic subjects, 19 males and 12 females, with a mean age of 40.5 +/- 14.0 years, 17 of whom were insulin dependent (IDDM) and 14 non-insulin dependent (NIDDM) treated with insulin and diet, were followed for a period of six months. Patients were diagnosed of diabetic autonomic cardiopathy (without other neuropathy causes, nor use of drugs except for insulin) by the alteration of at least 2 of the 5 cardiovascular tests (tCV) performed. Patients underwent an educational diabetes program and self-control, and after 6 months of treatment they were divided into two groups according to the degree of metabolic control. In group 1, in which there was a good control with mean blood sugar levels of 108 +/- 12 mg/dl (5.9 +/- 0.6 mmol/l) and triglycerides of 101 +/- 21 (1.1 +/- 0.2 mmol/l), an improvement in tCV was observed: Valsalva coefficient of 1.16 +/- 0.13 and 1.22 +/- 0.13 (initial and final respectively) (p less than 0.001), with and improvement in 56% of cases; E/I (expiration/inspiration) ratio increased from 1.13 +/- 0.11 to 1.21 +/- 0.11, improving 53% of cases (p less than 0.001); 30/50 index (RR in 30/RR beat in beat 15 after orthostatism) (n.s.); difference in systolic arterial pressure after standing (p less than 0.001) and increase in diastolic arterial pressure with isometric muscular exercise (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

[Hyperplasia of the pancreatic islets or nesidioblastosis in adults? Apropos 2 cases]. / Hiperplasia de islotes pancreáticos o nesidioblastosis del adulto? A propósito de dos casos.

Nesidioblastosis is an anatomopathological situation defined as the transformation or the exocrine ductal epithelium into endocrine tissue which can be hormonally active or inactive. In this study we present two cases which to our knowledge fulfil criteria for nesidioblastosis. Both patients were male (73 and 45 years, respectively) who were admitted to our department because they presented hypoglycemia. Blood examination revealed the existence of an hyperinsulinism although axial computerized tomography, pancreatic echocardiography and selective angiography of the celiac arterial trunk failed to demonstrate the presence of the tumor in either of the two cases. Due to the persistence of the clinical picture in the first case and to the intolerance to the diazoxide in the second patient, a subtotal pancreatectomy was performed in both cases. The surgical procedure involved removal of the 80% and 75% of the head and body respectively. Both patients are presently free of symptoms although the first patient in under diazoxide therapy due to persistent hypoglycemia (more spaced crisis).

[Buccal manifestations of type I diabetes mellitus. Study of its oral symptomatology and dental involvement]. / Manifestations buccales du diabète sucré type I. Etude de sa symptomatologie orale et incidence dentaire.

We are hereby presenting a survey conducted on 44 diabetic patients of the I type and 44 health individuals used as a reference group. In the light of the results of the survey in question a poorer oral hygiene for the I type insulin-dependent diabetic patients than for those in the control group has been detected (E.G. whereas 40.91% of the diabetic patients exhibited a very poor hygiene, the rate detected for the control group amounted to 22.72% only). Nevertheless, this poorer hygiene did not seem to influence caries level direct since no meaningful difference in the two groups CAO indexes was detected at all. Cellulitis was very frequent in the diabetic group whereas post-extraction alveolitis and mouth dryness were found at comparable levels in the two groups.