Course of metabolic syndrome following the biliopancreatic diversion of Larrad.

BACKGROUND: The authors assessed the effect of Larrad's biliopancreatic diversion (BPD) on the main components of the metabolic syndrome. PATIENTS AND METHODS: Plasma concentrations of glucose, insulin, total cholesterol (TC), HDL and LDL cholesterol, triglycerides, LDL/HDL and TC/HDL ratios, and blood pressure and body weight were retrospectively evaluated in 40 patients 3-6, 12, 24 and 60 months after undergoing BPD for morbid obesity with metabolic syndrome. RESULTS: 3-6 months after BPD, glycemia and insulinemia had normalized in 97.5% of the patients and remained stable over the following 5 years. Over this period of 3-6 months to 5 years following BPD, total and LDL cholesterol levels fell by 45.2% and 53.1%, respectively. From 12 months onwards, triglyceride levels decreased appreciably, dropping by 57.4% at 5 years. HDL cholesterol concentrations failed to vary significantly or increased to normal levels in patients showing low initial values. At 5 years, high blood pressure had resolved in 75% of patients and the amount of excess weight lost was 65.5% (+/-14.6). No patient required reversal of the BPD due to severe gastrointestinal or metabolic complications. CONCLUSIONS: Technically adapted to the patient's weight, the Larrad BPD effectively stabilizes the main components of the metabolic syndrome. The BPD has low morbidity rate and should be considered a therapeutic option for patients who do not respond to medical treatment.

[Bariatric surgery: an update]. / Cirugía bariátrica: situación actual.

The indication of bariatric surgery as therapeutic procedure for morbid obese patients requires the application of selection criteria which deal with the degree of obesity, associated complications and previous failure of conventional therapy. Alcohol or drug addiction and concomitant serious disease are contraindications for bariatric surgery. Before operation, a full assessment is needed to identify possible eating behaviour disturbances and associated comorbidity such as cardiovascular disease, sleep apnoea, metabolic and psychiatric alterations which might induce intra and postoperative complications. Surgical techniques can be classified as restrictive, malabsortive and mixed procedures. Gastroplasty and adjustable gastric banding are restrictive techniques, which are indicated in obese patients with body mass index less than 45 kg/m2. Mixed techniques are the most used procedures. They include gastric by-pass which causes a reduction of 60-70% of weight excess, biliopancreatic diversion and duodenal switch which can eliminate a 75% of body weight excess. Following bariatric surgery a dramatic improvement in associated comorbidity can be demonstrated, specially in what refers to diabetes, hypertension, dislipidaemia and apnoea. Postoperative mortality is around 1-2%. Peritonitis and venous thromboembolism are the most serious complications. Postoperative follow-up should be lifelong and requires a progressive nutrition planning and vitamin supplementation.

[Cushing's syndrome secondary to bronchial carcinoid tumor: contribution of gammagraphy with 111In-DTPA octreotide in the localization diagnosis]. / Síndrome de Cushing secundario a tumor carcinoide bronquial: valor de la gammagrafía con 111In-DTPA octreotide en el diagnóstico de localización.

Bronchial carcinoid (BC) is a rare etiology of Cushing syndrome, and difficulties in differential diagnosis with Cushing's disease are often present. We report two cases in which octreotide scintigraphy was an important diagnostic tool. The first patient showed a 1 cm non-specific pulmonary nodule on CT scan that was positive on scintigraphy, being confirmed by surgery. The second case was a man that had been operated but not cured of an ACTH secreting BC that continued with high ACTH levels and negative localization imaging studies. A subsequent scintigraphy showed a positive image suggestive of recurrence. Octreotide scintigraphy may be considered in patients with suspicion of ectopic ACTH syndrome although a positive image in CT scan be present.

[Amylin: its potential role in the etiopathogenicity of diabetes mellitus]. / Amilina: su posible papel en la etiopatogenia de la diabetes mellitus.

The recent discovery that IAPP, or amylin, a polypeptide solubilized from the amyloid substance found in the islets of Langerhans of most type II diabetics, is secreted along with insulin by beta cells and possesses anti-insulinic effects has opened new perspectives in the etiopathogenesis of this type of diabetes. Many data suggest a possible hormonal mechanism acting on perypheral targets, though so far effects have only been observed with supraphysiological doses. Other reports suggest amylin would have a deleterious effect on beta cells, because of its deposition in the form islet amyloid.

One year treatment with clonidine in children with constitutional growth delay.

The therapeutic potential of clonidine was evaluated in 112 prepubertal children with short stature, delayed bone age and a growth velocity of 4.1 +/- 0.4 cm/yr in boys and 4.2 +/- 0.5 cm/yr in girls. The alpha 2 agonist was orally administered at 0.075 mg/m2 to 51 boys and 39 girls over a period of at least one year, and the effect compared to a vitamin treatment given to 10 age matched boys and 12 age matched females showing similar growth velocities. After one year of treatment growth velocity was increased to 6.6 +/- 1.2 cm/yr in boys and 6.50 +/- 1.0 cm/yr in girls treated with the drug, whereas in those given vitamins only 4.9 +/- 0.7 cm/yr in boys and 5 +/- 0.6 cm/yr in girls was recorded. Bone age remained 1.5 +/- 0.3 yr behind chronological age in both vitamin and clonidine treated groups. If only the 65% of patients that show a growth velocity increment of more than 2 cm/yr are considered the growth velocity reaches 7.20 +/- 0.82 cm/yr in boys and 6.68 +/- 0.75 cm/yr in girls, indicating that clonidine may be a useful pharmacological agent in the treatment of some patients with constitutional growth delay. The remaining 35% patients do not show any significant increase in growth velocity.

[Relations between Sheehan's syndrome and empty sella turcica. A functional study apropos of 6 cases]. / Relación entre síndrome de Sheehan y silla turca vacía. Estudio funcional a propósito de 6 casos.

We evaluated six patients in whom a diagnosis of Sheehan's syndrome had been made. The plasma levels of the following hormones were measured: basal thyroxine (T4), estradiol and cortisol; and also follicle-stimulating hormone (FSH), luteinizing hormone (LH), growth hormone (GH), thyrotropin (TSH), prolactin (PRL) and adrenocorticotropic hormone (ACTH), basally and after acute challenge with LH releasing hormone (LHRH), GRF (1-29)NH2 or insulin hypoglycemia, TSH releasing hormone (TRH) and lysine-8-vasopressin, respectively. Two patients underwent chronic LHRH stimulation by pulsatile subcutaneous administration with infusion pump. In 4 cases, computed tomography (CT) was performed although cranial X-ray study was normal. A severe and generalized pituitary involvement was found in all patients, 3 of whom had diabetes mellitus. Probably, more insidious cases go unnoticed. The presence of asymptomatic partial empty sella (ES) in all the CTs that were carried out raises the possibility that it is another evolutive feature of SS.

[MEN I (multiple endocrine neoplasia): patient screening and new tumor markers]. / MEN I: Screening de pacientes y nuevos marcadores tumorales.

Multiple endocrine neoplasia type I (men I) associates hyperparathyroidism with pancreatic tumors. The evaluation included the patient and its family, periodically. A good patient medical history, biochemical blood tests, carried out regularly and in an organised fashion, brings to the fore the diagnosis without difficulties. Tumoral markers are now being considered an important test for diagnosis and follow-up (gastrin, pancreatic peptid, prolactin...). The newest chromogranin is a polypeptidic group which increases in the blood of patients with endocrine neoplasias (including hyperparathyroidism and tumors of pancreatic islet cells). The specific neural enolase is increase in pancreatic islet cells tumor. The evaluation of S-100 substance, 7-B2 protein, neurotensin, alpha sub-unit of chorionic gonadothrophin and other markers will soon be of help in the diagnosis of men I.

[Treatment of advanced breast cancer with tamoxifen (author's transl)]. / Tratamiento del cáncer avanzado de mama con tamoxifén.

Therapy with tamoxifen has been used in 109 woman with advanced breast carcinoma; 75 of them had been previously submitted to ovariectomy, hormonal treatment and or polychemotherapy. Tumors were localized in the breast in 21 cases, in the lymph nodes in 34 cases, in the dermis in 32 cases; there were 26 cases with lung metastases and 62 cases with bone metastases. Fifty-one patients showed multiple tumor involvement, but only 57 patients referred to have pain. Objective responses were obtained in 36 percent of the cases (15 patients with complete remission and 25 responses over 50 percent). An additional 30 percent of minor responses was also obtained. Pain disappeared in 68 percent of the cases. According to the tumor localization, objective responses were obtained in 26 out of 62 osseous metastases, in 16 out of 34 lymph node involvement, 12 out of 26 lung metastases, 12 out of 32 dermic localizations, and 6 out of 21 breast tumors. Drug tolerance was excellent, and maximum therapeutic response occurred between 3 and 15 months after beginning of treatment with tamoxifen. These results encourage the usefulness of tamoxifen in the treatment of patients with advanced breast carcinoma.