Osteoporosis in diabetes mellitus patients.

Diabetes mellitus (DM) is currently a pandemic problem, and the number of diabetic patients is constantly increasing. There are known and established diabetic complication but it is also comorbidities associated with DM cannot be forgotten. One of these is osteoporosis and osteoporotic fractures. In diabetic patients, the fractures are usually 2 to 6 times higher. In management of diabetes we should screen also the risk of osteoporosis and fractures. From a diabetic point of view, optimum glycaemic control should be achieved, however, we should take into account the effect of antidiabetic agents on bone. In this summary data on the diagnosis and treatment of osteoporosis in patients with DM as well as on the effect of antidiabetic agents on bone are presented.

Thyroid-stimulating hormone concentration as an independent risk factor of venous thromboembolism regardless of thyroid function.

INTRODUCTION: Thyroid dysfunction has been recognised as playing a role in the coagulation cascade, but the clinical implications of this phenomenon are unclear. The aim of our study was to assess the predictive power of TSH measurement on the presence or absence of venous thromboembolism (VTE). MATERIAL AND METHODS: From January 2009 to August 2012, all consecutive patients hospitalised for suspected VTE were included in the study. VTE was confirmed either by pulmonary angiography or compressive ultrasound. We investigated the predictive power of TSH concentration on the risk of VTE in univariate and multivariate analysis including the existing risk factors (age, D-dimer). RESULTS: A total of 232 patients were eligible for final analysis, with a median age of 70 years (IQR 58-80) and male-to-female ratio of 124:108. VTE was confirmed in 124 patients (53.4%). TSH concentration was significantly higher in cases with VTE (median 2.17 vs. 1.76 mIU/L, p = 0.0104), but free T4 concentrations were not found to be significantly different. Receiver operating curve analysis identified the cut-off of TSH > 2.686 mIU/L as a predictor of VTE with the prevalence of VTE 47.1 vs. 66.7% below and above this cut-off, p = 0.011. Multivariate logistic regression identified five independent predictors of VTE: male gender (odds ratio, OR = 2.22), D-dimer > 0.5 mg/L OR = 16.42), CRP > 5 g/L (OR = 9.178), TSH > 2.686 mIU/L (OR = 2.269), and age (OR = 0.9767/year). CONCLUSIONS: Among patients with suspected venous thromboembolism TSH concentration was found to be an independent predictor of VTE in addition to gender, D-dimer, C-reactive protein (CRP), and age.

Death in consequence of late failure of endoscopic third ventriculostomy.

INTRODUCTION: Late failure of originally successful endoscopic third ventriculostomy (ETV) is considerably less common than failure of ventriculo-peritoneal (V-P) shunt in treatment of hydrocephalus. Death in consequence of late ETV failure is a very rare complication, so far having been mentioned in literature in 13 patients only. CASE REPORT: We present the case of an 11-year-old girl who died in consequence of ETV failure 26 months after the endoscopic procedure. Histopathology proved the closure of stoma by gliotic tissue. CONCLUSION: We can assume that reduced compliance of the ventricular wall in long-term V-P shunt, aqueductal stenosis as a cause of hydrocephalus as well as rapid onset of clinical symptoms prior to ETV might be the cause of acute onset of intracranial hypertension after late ETV failure. Potential prevention of sudden death seems to be the implantation of subcutaneous reservoir during the endoscopic procedure, which allows simple and rapid reduction of intraventricular pressure.