Esclerosis con etanol de un quiste paratiroideo no funcionante / Percutaneous ethanol injection of a nonfunctioning parathyroid cyst

Se describe el caso singular de una paciente de 21 años de edad, afectada de una tumoración cervical anterior indolora de 3 cm, cuyo estudio mediante punciónaspiración con aguja fina, ecografía cervical y analítica de sangre puso de manifiesto que se trataba de un quiste paratiroideo único no hiperfuncionante. Doce meses después de la evacuación del contenido quístico se produjo una recidiva, que se trató mediante una nueva punción-evacuación, pero en esta ocasión con inyección percutánea de etanol absoluto, consiguiéndose la resolución clínica. En el control ecográfico a los 14 meses no se apreciaron lesiones residuales. Se discute el abordaje terapéutico de los quistes de paratiroides y, en concreto, la elección de la esclerosis percutánea con etanol como terapia de primera opción (AU)

Differential influence of LDL cholesterol and triglycerides on lipoprotein(a) concentrations in diabetic patients.

OBJECTIVE: To evaluate the relationship between plasma lipid profiles and lipoprotein(a) [Lp(a)] concentrations in diabetic patients, taking into account the Lp(a) phenotype. RESEARCH DESIGN AND METHODS: We included 191 consecutive diabetic outpatients (69 type 1 and 122 type 2 diabetic patients) in a cross-sectional study Serum Lp(a) was determined by enzyme-linked immunosorbent assay, and Lp(a) phenotypes were assessed by SDS-PAGE followed by immunoblotting. The statistical methods included a stepwise multiple regression analysis using the Lp(a) serum concentration as the dependent variable. The lipid profile consisted of total cholesterol, HDL cholesterol, LDL cholesterol, corrected LDL cholesterol, triglycerides, and apolipoproteins AI and B. RESULTS: In the multiple regression analysis, LDL cholesterol (positively) and triglycerides (negatively) were independently related to the Lp(a) concentration, and they explained the 6.6 and 7.8% of the Lp(a) variation, respectively. After correcting LDL cholesterol, the two variables explained 3.8 and 6.4% of the Lp(a) variation, respectively. In addition, we observed that serum Lp(a) concentrations were significantly lower in patients with type IV hyperlipidemia (mean 1.0 mg/dl [range 0.5-17], n = 16) than in normolipidemic patients (6.5 mg/dl [0.5-33.5], n = 117) and in type II hyperlipidemic patients (IIa 15.5 mg/dl [3.5-75], n = 13; IIb 9 mg/dl [1-80], n = 45); P < 0.001 by analysis of variance. CONCLUSIONS: Lp(a) concentrations were directly correlated with LDL cholesterol and negatively correlated with triglyceride levels in diabetic patients. Therefore, our results suggest that the treatment of diabetic dyslipemia may indirectly affect Lp(a) concentrations.

Relationship between lipoprotein(a) phenotypes and plaminogen activator inhibitor type 1 in diabetic patients.

It has been demonstrated in vitro that lipoprotein(a) [Lp(a)] increases the endothelial synthesis of plasminogen activator inhibitor 1 (PAI-1). However, this effect in vivo is controversial, and the possible relationship between PAI-1 and Lp(a) phenotypes has not been evaluated. The aim of the study was to determine the influence of Lp(a) and its phenotypes on PAI-1 serum concentrations in diabetic patients. For this purpose we include 75 Caucasian diabetic patients (34 consecutive type I and 41 consecutive type II) without late diabetic complications. Lp(a) and PAI-1 were assessed by ELISA. Lp(a) phenotypes were determined by SDS-PAGE followed by immunoblotting, and grouped according to size in small (F,B,S1,S2), big (S3,S4), and null. A linear correlation between Lp(a) and PAI-1 was not observed either as a whole or when type I and type II diabetic patients were analyzed separately. However, significant differences were detected in PAI-1 levels when Lp(a) phenotypes were considered (small: 42.1+/-31.8 ng/mL; big: 37.2+/-26.1 ng/mL; null: 14.4+/-14.4; p< 0.05). The significant differences were due to the low PAI-1 concentrations observed in patients with null phenotype. Our results suggest that fibrinolytic activity might be preserved in diabetic patients with null Lp(a) phenotype. Furthermore, it could be speculated that diabetic patients with null phenotype should be considered at low risk to develop cardiovascular disease.

Falso positivo del rastreo con radioyodo debido a un quiste nasolabial, en una paciente con carcinoma folicular de tiroides / Nasolabial cyst as a cause of false-positive radioiodines can in a patient with follicular thyroid cancer

Se describe el caso de una paciente afectada de un carcinoma folicular de tiroides, con una tumoración paranasal captante de radioyodo en el rastreo, con aspecto de metástasis en la tomografía computarizada, y tiroglobulina inferior a 3 ng/ml. Para su tratamiento, recibió dos ciclos terapéuticos de dicho isótopo radiactivo (100 y 150 mCi; 3.700 y 5.550 MBq), pues aunque tras el primero la tumoración desapareció, recidivó 5 años después con características similares. En esta segunda ocasión, por persistencia de la lesión, se llevó a cabo un abordaje quirúrgico que reveló que se trataba de un quiste nasolabial, y, por tanto, de un caso de falso positivo del rastreo con radioyodo por esta causa. Se revisa la enfermedad del quiste nasolabial y se discute la problemática de los falsos positivos del rastreo con radioyodo en pacientes con carcinoma diferenciado de tiroides (AU)

Relationship of lipoprotein(a) and its phenotypes with the albumin excretion rate in diabetic patients: a multivariate analysis.

BACKGROUND/AIM: The possible association between lipoprotein(a) [Lp(a)] and albumin excretion rate (AER) is a topic that has generated conflicting views. The aim of this study was to determine the relationship between serum Lp(a) concentrations and AER in diabetic patients, taking into account Lp(a) phenotypes in a multivariate analysis. METHODS: For this purpose 191 consecutive diabetic patients (69 type 1 and 122 type 2) were included in the study. Lp(a) was determined by ELISA and its phenotypes by SDS-PAGE followed by immunoblotting. Lp(a) phenotypes were grouped by size in small (F, B, S1, S2), big (S3, S4) and null. RESULTS: Diabetic patients with an AER >20 microg/min presented higher Lp(a) concentrations than patients with an AER <20 microg/min: median 19 mg/dl versus 5 mg/dl (p < 0.0001). The differences remained at a significant level when the type of diabetes was considered. A linear correlation was observed between Lp(a) concentration and AER (type 1: r = 0.32, p = 0.01; type 2: r = 0.25, p < 0.05). The AER was independently correlated with Lp(a) concentrations in a multiple regression analysis (p < 0.01), and Lp(a) was independently associated with the presence of diabetic nephropathy in the logistic regression analysis. The overall frequency distribution of Lp(a) phenotypes differed significantly between patients with or without microalbuminuria (p < 0.05). In addition, the AER (microg/min) was different among the Lp(a) phenotypes: small 55 +/- 122 (median 4.9), big 58 +/- 123 (median 5.7) and null 3 +/- 2 (median 2.3); p = 0.01. The significant difference mainly resulted from low AER (<10 microg/min) detected in all patients with the null phenotype. CONCLUSIONS: In diabetic patients the serum Lp(a) concentration is associated with AER. Thus, the elevated cardiovascular risk observed in diabetic patients with a high AER could be related to the Lp(a) concentration. Finally, patients with the null Lp(a) phenotype can be considered as a group at low risk of the development of diabetic nephropathy.

[Lipoprotein (a) and the evaluation of low density cholesterol by the Friedewald formula: a new problem for an old equation]. / Lipoproteína(a) y estimación del colesterol LDL mediante la fórmula de Friedewald: un nuevo problema para una vieja ecuación.

BACKGROUND: To evaluate the influence of lipoprotein(a) [Lp(a)] concentration on the LDL-cholesterol calculated by the Friedewald formula. MATERIAL AND METHODS: Lp(a) was determined to a worker population of 947 subject in order to perform a correction of LDL-cholesterol obtained by the Friedewald formula. RESULTS: In subjects in whom Lp(a) was > 30 mg/dl (12.9%) LDL-cholesterol levels were overestimated 10 mg/dl at least. CONCLUSION: Lp(a) should be considered in order to reduce Friedewald's formula error on the estimation of LDL-cholesterol.

[Fibronectin and diabetes mellitus: the factors that influence its plasma concentrations and its usefulness as a marker of late complications]. / Fibronectina y diabetes mellitus: factores que influyen en las concentraciones plasmáticas y utilidad como marcador de complicaciones tardías.

BACKGROUND: The usefulness of plasma fibronectin (FNp) as a marker of late diabetic complications is controversial. The aim of the study was to assess the influence of several variables on FNp in diabetic patients and to determine its usefulness as a marker of late diabetic complications. PATIENTS AND METHODS: 79 diabetic patients randomly selected were included in the study. The clinical variables considered were: age, gender, body mass index (BMI), tobacco and alcohol consumption, type, duration and treatment of diabetes, hypertension, and diabetic late complications (macroangiopathy, retinopathy, nephropathy and neuropathy). The laboratory variables analyzed were: blood glucose, glycated hemoglobin, total cholesterol, HDL-cholesterol, LDL-cholesterol, tryglicerides, apolipoprotein AI, apolipoprotein B, microalbuminuria, creatinin and FNp. Statistical study included a multiple regression analysis taking FNp as the dependent variable. RESULTS: A direct correlation between FNp and BMI and also with tryglicerides was observed (r = 0.362; p = 0.002, and r = 0.234; p = 0.038, respectively). Higher levels of FNp were found in type 2 diabetic patients in comparison with type 1 (464 [SD, 127] versus 395 [SD, 96] mg/dl; p = 0.014). This difference was due to the higher BMI and tryglicerides concentrations observed in type 2 diabetic patients in comparison with type 1 (28.61 [SD, 4.67] versus 22.56 [SD, 2,.19] kg/m2; p < 0.001, and 4.24 [SD, 2.36] versus 2.52 [SD, 1.40] mmol/l, respectively). Multiple regression analysis showed that only BMI significantly influenced on FNp concentrations (r = 0.330; p = 0.004). No relation among FNp and late diabetic complications and other variables considered in the study was observed. CONCLUSIONS: FNp is not a useful marker of diabetic late complications and its concentrations are direct and independently influenced by BMI.

Prevalence of osteomyelitis in non-healing diabetic foot ulcers: usefulness of radiologic and scintigraphic findings.

The study was conducted in order to assess the prevalence of osteomyelitis and the predictive value of radiographic (xR) and combined Tc 99-bone and leukocyte scanning (CS) findings in diabetic foot ulcers that met criteria for hospital admission (FUH). Out of 150 episodes of ulceration managed in an outpatient basis, 33 (in 28 NIDDM patients) requiring admission were evaluated. In all cases plain xR and CS were carried out. Seventeen episodes (51.5%) had a good outcome (healed or improving, at the time of the last follow up). Osteomyelitis was found in 21 episodes and 14 (66.6%) of them required an amputation. In 13 cases where xR showed characteristic radiologic changes of osteomyelitis (11 of them had a positive CS) 11 (84.6%) underwent an amputation. However, when osteomyelitis was diagnosed only by a positive CS, only 3/8 (37.5%) required a toe amputation. Severe peripheral vasculopathy was present in 44% of cases who required amputation and only in 17.6% of those who did not. We conclude that in FU underlying osteomyelitis is frequent and associated to a higher amputation rate than when no bone infection is identified (66.6 vs 17%), even when corrected for vascular status (OR 11, CI 95% 1.65-74.2), with a worse outcome when xR changes are already present.

Serum concentrations of laminin-P1 in diabetes mellitus: usefulness as an index of diabetic microangiopathy.

OBJECTIVE: To assess the influence of several variables on serum laminin-P1 (Lam-P1) and to evaluate its usefulness as a serum marker of diabetic microangiopathy. MATERIAL AND METHODS: We determined Lam-P1 by serum radioimmunoassay in 121 controls and 176 diabetic patients, 58 type 1 (insulin dependent) and 118 type (non-insulin dependent), grouped according to retinal status and urinary albumin excretion. The variables evaluated were: age, gender, body mass index, blood pressure, consumption of tobacco and alcohol, type of diabetes, duration of disease, fasting blood glucose, HbA1, cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides and apolipoproteins (A1, B). Imprecision for laminin determination was: 3.6% intrassay; 5.8% interassay. STATISTICS: Student's t-test, ANOVA, ANCOVA, and multiple regression analysis. RESULTS: In diabetic patients Lam-P1 was higher than in controls (X = 1.63 +/- S.D. 0.36 vs. X = 1.40 +/- S.D. 0.18 U ml-1; P < 0.001) and only correlated with age (P = 0.002). Lam-P1 was higher in diabetics with proliferative retinopathy than in patients with non-proliferative retinopathy and without retinopathy (X = 2.17 +/- S.D. 0.49 U ml-1 vs. X = 1.71 +/- S.D. 0.22 U ml-1 vs. X = 1.47 +/- S.D. 0.26 U ml-1; P < 0.001). Patients with macroalbuminuria presented higher serum Lam-P1 than patients with micro or normoalbuminuria (X = 2.39 +/- S.D. 0.53 U ml-1 vs. X = 1.78 +/- S.D. 0.23 U ml-1 vs. X = 1.51 +/- S.D. 0.29 U ml-1; P < 0.001). These differences remained significative when patients were age-adjusted. CONCLUSIONS: Lam-P1 could be useful as an index of diabetic microangiopathy but patient's age should be considered.

[Follicular cancer of the thyroid: atypical presentation]. / Cáncer folicular de tiroides de presentación atípica.

Follicular thyroid carcinoma usually presents as a thyroid nodule, with rare cases showing metastatic disease at diagnosis. We present a patient with follicular thyroid carcinoma who was diagnosed as a large pelvic metastatic mass with a biochemical profile of subclinical hyperthyroidism. She was treated with local-field radiotherapy, since surgical resection was not possible and radioiodine therapy would be of little benefit due to its large volume. She is currently in continuous remission two years from diagnosis.

Tamoxifen failure in medullary thyroid carcinoma.

We report the results of short-term tamoxifen treatment (20 mg two times a day orally) in 2 patients with metastatic medullary thyroid carcinoma. Patient A had a rapid tumor progression with development of Cushing's syndrome before initiation of tamoxifen treatment. Patient B had a slowly progressive course. In both cases, neither clinical nor biochemical improvement were observed, after 1 and 3 months of tamoxifen therapy, respectively.

[Clinical usefulness of adrenal gland computed tomography in the etiologic diagnosis of Addison's disease]. / Utilidad clínica de la tomografía computadorizada suprarrenal en el diagnóstico etiológico de la enfermedad de Addison.

BACKGROUND: The aim of this study was to evaluate adrenal gland morphology by computerized tomography (CT) in the etiologic diagnosis of Addison's disease. METHODS: Twenty-two patients were grouped according to their etiology based on the study of antiadrenal antibodies at diagnosis of the disease: 7 were positive (autoimmune etiology or EAA), 11 were negative (tuberculous etiology or EAT) and in four serologic study was not available (undetermined etiology or EAI). Adrenal gland CT was performed with contiguous sections every 5 mm. In eight cases the examination was carried out upon diagnosis of the disease (initial stage) and in 14 between 2 and 17 years following diagnosis (evolutive stage). RESULTS: In all the patients of the EAA group, examined in either the initial or evolutive stages, the adrenal glands appeared atrophic without calcifications. In the patients of the EAT group adrenal masses of proven tuberculous origin were found in five who were studied in the initial stage and with atrophic glands with calcifications in the remaining patients examined in the evolutive stage, with the exception of two cases with atrophic adrenal glands without calcifications which could serologically be considered as false negatives having autoimmune etiology. The patients in the EAI groups were studied in the evolutive stage with three having atrophic glands with calcifications and one atrophic adrenal glands without calcifications. CONCLUSIONS: Adrenal gland computerized tomography is an useful examination to differentiate between autoimmune or tuberculous origin in Addison's disease. Clinical application may be justified in all patients of recent diagnosis when the study of the antiadrenal antibodies is negative or not possible.

[Platelet hyperactivity in diabetic retinopathy: etiologic factor or epiphenomenon of microangiopathy?]. / Hiperactividad plaquetaria en la retinopatía diabética: factor etiológico o epifenómeno de la microangiopatía?

In order to analyze the etiologic and pathogenic meaning of platelet activity in diabetic retinopathy, Plasmatic Beta-Thromboglobulin (BTG) has been determined in 42 diabetics without retinopathy, 14 diabetics with non proliferative retinopathy and in 29 health controls. BTG showed higher values in diabetic patients with retinopathy in comparison with diabetics with no retinopathy (46.4 +/- 10.7 versus 37.6 +/- 13.4 ng/ml; p < 0.05 and with controls (31 +/- 18.8; p < 0.005). There were no differences between diabetics with no retinopathy and controls. No relation was found between BTG and the glycemic control grade, neither with lipoproteic profile. In resume, platelet hyperactivity found in patients with retinopathy seems to be an epiphenomenon of the microangiopathic lesion and not an etiologic factor, however this not precludes that it can play a role in the progression on retinal lesions.

[Glycemic control and lipoprotein profile in type I diabetes mellitus]. / Control glucémico y perfil lipoproteico en la diabetes mellitus tipo I.

BACKGROUND: To analyze the relation between the degree of glycemic control and the lipoprotein profile in type I diabetes mellitus. METHODS: Seventy-five diabetics were studied in whom the total glycohemoglobin (GHb), total triglycerides (TG), triglycerides of very low density lipoproteins (TG-VLDL), total cholesterol (TC), cholesterol of very low density lipoproteins (C-VLDL), cholesterol of high density lipoproteins (c-HDL), apolipoprotein AI (Apo AI) and apolipoprotein B (Apo B) were determined. Patients were classified according to their GHb: less than 9% (good glycemic control), 9-11% (moderate glycemic control) and greater than 11% (bad glycemic control). There was homogeneity in the 3 groups with regards to other variables which influenced the lipoprotein profile. RESULTS: The concentrations of TG, TG-VLDL, TC, C-VLDL and C-LDL were significantly higher in the groups of greater GHb while those of C-HDL, Apo I and Apo B were independent of the degree of glycemic control. The number of patients whose lipid profiles may be considered as atherogenic risk increases progressively in groups with greater GHb. CONCLUSIONS: In patients with type I diabetes mellitus, bad glycemic control is accompanied by decreases in TG, TC and C-LDL up to a magnitude which frequently reaches risk values for developing vascular disease. However, in these subjects, a less protector effect dependent on C-HDL is not to be expected since their concentrations are similar to those patients with good glycemic control.