[Clinical experience with an alpha glucosidase inhibitor (acarbose) in the treatment of non-insulin-dependent diabetes. Multicenter study]. / Experiencia clínica con un inhibidor de la alfa glucosidasa (acarbosa) en el tratamiento de la diabetes no insulinodependiente. Estudio multicéntrico.

BACKGROUND: Acarbose, an alpha glucosidase inhibitor is a drug used in the treatment of non insulin dependent diabetes mellitus, that interferes with the intestinal absorption of monosaccharides. AIM: To study the effect of acarbose in non insulin dependent diabetic patients that had an inadequate metabolic control with diet and sulphonylureas. PATIENTS AND METHODS: Diabetic patients received acarbose, 150 mg/day during four weeks and this dose was increased to 300 mg/day during 3 months. Afterwards, patients were followed for a period of 12 weeks without acarbose. Fasting and post-prandial blood glucose and glycosilated hemoglobin were measured sequentially during the study. RESULTS: Eighty five patients were recruited for the study but 64 complied with the treatment protocol. The age of these patients was 56 +/- 8.8 years old, their diabetes duration was 7.8 +/- 8.8 years and their body mass index was 27.6 +/- 3.6 kg/m2. During acarbose treatment, glycosilated hemoglobin decreased from 8.36 +/- 1.33 to 7.71+ 1.7% (p < 0.001), fasting blood glucose decreased from 173 +/- 48 to 159 +/- 59 mg/dl (p < 0.03) and post-prandial blood glucose decreased from 254 +/- 80 to 241 +/- 80 mg/dl (NS). After discontinuing acarbose glycosilated hemoglobin and blood glucose levels returned to basal levels. Body weight and blood pressure did not change during the treatment period. Fifty nine patients had gastrointestinal symptoms (meteorism, flatulence and abdominal distention) that were mild in 59% and moderate in 39%. Episodes of hypoglycemia were not observed. CONCLUSIONS: Acarbose, associated to sulphonylureas is an effective drug to reduce blood glucose and glycosilated hemoglobin levels in patients with non insulin dependent diabetes.

[Chemical, sensory and clinical characterization of lupin marmalades]. / Caracterización química, sensorial y clínica de mermelada de lupino.

Legumes are characterized as showing interesting hypoglicemic properties. Their presence in the diet is very useful in controlling the level of blood glucose in diabetic people. Taking in mind this property different formulations of prune marmalades were developed using 5, -7.5, 10 and 15% of full fat sweet lupin flour (FFLF). These samples were submitted to chemical, physical, sensory and clinical analysis. The protein content increased from 0.6 to 5.2% in direct proportion to lupin flour concentration. Energy content remained relatively constant in all formulations. The incorporation of FFLF did not affect the natural dark red prune color and pH, acidity and soluble solids values remained under the limits of Chilean food regulation laws. The samples were analyzed by a Rank preference test. Reported data showed a significative preference for the prune marmalade with 10% HEL (p < 0.05). A facial Hedonic test was used to compare the degree of acceptability between this formula and a control marmalade with fructose as edulcorant. Statistical analysis using the student test did not show significant difference (p < 0.05) between them. The hypoglycemic effect of the lupin flour was tested in seven adult non insulin dependent diabetic patients using the glucose tolerance test. Postprandial blood glucose concentration data was lower in individuals after a test meal of lupin marmalade compared to fructose marmalade. This result would allow diabetic people to eat foods such as marmalades which are known to contain a large amount of carbohydrates.

[Primary hyperparathyroidism caused by a mediastinal adenoma with intermittent hypercalcemia and severe bone disease]. / Hiperparatiroidismo primario por adenoma mediastínico, con hipercalcemia intermitente y enfermedad ósea acentuada.

We report the case of a 33-year-old woman who was operated on with the diagnosis of primary hyperparathyroidism (PHP) in 1986. She had bone disease and slight hypercalcemia. Two parathyroid glands were removed with a lack of clinical improvement. Subsequently, the serum calcium levels were normal with occasional slight increases. Depressed phosphorus values and elevated alkaline phosphatases and PTH levels were also present, associated with severe bone involvement and muscular weakness. A second cervical exploration performed in 1989 disclosed only a normal parathyroid gland, which was not removed. In 1990, a thoracic CT scan showed the presence of a 1 cm mediastinal nodule close to the great vessels. A thoracotomy was performed to remove this nodule, which proved to be a parathyroid adenoma. After surgery, the patient presented with a "hungry bone" syndrome, characterized by very low levels of calcium, phosphorus and magnesium, which required enteral and parenteral calcium and magnesium supplements, plus dihydroxyvitamin D. The association of normocalcemia and intermittent hypercalcemia with severe bone disease is very rare, as is the presence of a mediastinal adenoma. This could explain the difficulty in the diagnosis in this case.