Combination of cardiorespiratory reflex parameters and heart rate variability power spectrum analysis for early diagnosis of diabetic cardiac autonomic neuropathy.

AIM: The study objective was to compare cardiorespiratory reflex (CR-R) parameters and heart rate variability power spectrum (HRV-PS) analysis in the diagnosis of cardiac autonomic neuropathy (CAN) in diabetic patients. METHODS: Four CR-R tests (Valsalva manoeuvre, deep breathing, and two successive 5-minute periods with the subject supine and standing, respectively) were performed in 399 diabetic patients (58.6% male, median age: 51 years) and 105 healthy controls (40% male, median age: 34 years). Patients with two or more abnormal CR-R parameters were classified as CAN+, while those with only one abnormal CR-R parameter were considered CAN 'borderline'. HRV-PS was performed in all study participants. RESULTS: The low-frequency (LF) area with the patient standing was reduced in CAN+ diabetics (median 35.6 normalized units [nu], n=31), in CAN 'borderline' diabetics (median 64.3nu, n=70) and even in diabetics without CAN (median 89.4nu, n=298) versus control subjects (median 93.7nu; P<0.001, P<0.001 and P<0.05, respectively). Adding the abnormal (<2.5 nu) LF area to the diagnostic criteria in CAN 'borderline' patients caused 11 (15.7%) patients to be considered CAN+. CONCLUSION: Combining abnormal CR-R parameters (I - E and I/E the most specific) with HRV-PS (particularly the LF area with the subject standing) allowed diagnosis of diabetic CAN at an earlier stage.

[Recurrence and prognostic factors after treatment with antithyroid agents in Graves-Basedow disease. Multicenter study in Northern Spain]. / Recidiva y factores pronósticos tras tratamiento con antitiroideos en la enfermedad de Graves-Basedow. Estudio multicéntrico en el norte de España.

Therapy with anti-thyroid drugs is the initial option mostly used in our country for the treatment of hyperthyroidism due to Graves-Basedow disease. To evaluate the long term results of this kind of therapy, a total of 773 patients were studied who were diagnosed from 1975 to 1994 in three hospitals in Northern Spain (Hospital Central de Asturias, Hospital de Cruces and Hospital de Navarra) after a mean follow-up time after anti-thyroid drug withdrawal of 46 +/- 33.1 months. The results showed a likelihood of hyperthyroidism relapse of 42.9%, 59.8%, 67.9% and 78.9% at one, three, five and ten years, respectively. Goitre size was correlated very significantly with the likelihood of relapse (p < 0.0001). In contrast, only TBII positivity at the end of therapy among the remaining parameters (age, sex, goitre size, length of therapy, positivity of anti-thyroid antibodies and TBII) influenced significantly on the relapse likelihood (p < 0.05). In conclusion, after a long term follow-up after anti-thyroid therapy, a high relapse rate of hyperthyroidism in Graves-Basedow disease, which amounts up to 79% at ten years, was observed. Goitre size was the main predictive factor for this relapse.

[Prognostic factors of microalbuminuria in diabetes mellitus type 1]. / Factores pronósticos de microalbuminuria en la diabetes mellitus tipo I.

The prophylaxis in diabetic nephropathy begin with the knowledge of factors that affect on the microalbuminuria. We designed a retrospective study with a follow-up of 8.4 +/- 2.9 years, in 75 patients with diabetes mellitus type 1: group A (n = 34) with microalbuminuria: group B (n = 41) without microalbuminuria. We tried to know the factors related to the on set of albuminuria. The mean Hb A1c was: Group A 8.7 +/- 1.5%; Group B 8.1 +/- 1% (p < 0.02). Patients that actually have microalbuminuria presented several years before a blood pressure (TA) greater than the group without microalbuminuria (Group A: TA systolic [TAS] 124.5 +/- 13 versus Group B 110.6 +/- 1 mmHg; p < 0.0001); (Group A: TA diastolic [TAD] 69.2 +/- 7 versus Group B 66.6 +/- 6 mm Hg; p < 0.0001). We confirm the influence of metabolic control on the microalbuminuria's beginning and the arterial blood pressure is greater in the group of patients with microalbuminuria actually.

[Urologic manifestations of primary hyperparathyroidism]. / Manifestaciones urológicas del hiperparatiroidismo primario.

We report on 79 patients with primary hyperparathyroidism (PHPT) and analyze the urological manifestations, analytical and histopathological changes commonly encountered in this disease. The importance of repeating calcium studies in patients with recurrent calcium stone formation is underscored. The appropriate metabolic work up should be performed when elevated values are detected.

[An analysis of the cardiovascular maneuvers for the diagnosis of cardiovascular autonomic neuropathy]. / Análisis de las maniobras cardiovasculares para el diagnóstico de la neuropatía autonómica cardiovascular.

Fifteen reflex tests for the diagnosis of cardiovascular autonomic neuropathy (CAN) were evaluated in 90 controls and 154 diabetic patients. We found that age, baseline heart rate and body position differently influenced the tests. The best parasympathetic indexes were Valsalva, inspiration minus expiration (I-E) and orthostatism indexes. We found minimal normality values for the three indexes, in individuals below age 50 years and in those aged 50 years or more, of 1.35 and 1.14, 12 and 7, and 1.16 and 1.12, respectively. Parasympathetic neuropathy was more common (68%) and it preceded the sympathetic (3%). CAN developed in 44% of the diabetics without neuropathy, in 63% of those without peripheral neuropathy, and in 84% of those with autonomic symptoms. CAN is associated with neuropathy lasting for more than 10 years.

[Effect of treatment of idiopathic hypogonadotropic hypogonadism with an LHRH infusion pump]. / Efecto del tratamiento del hipogonadismo hipogonadotropo idiopático con bomba de infusión de LHRH.

Treatment of idiopathic hypogonadotropic hypogonadism with an intermittent LHRH infusion pump is more physiologic than the repeated injections of gonadotropin previously used. The results of treating 7 patients, 5 males and 2 females, with this new method are presented. A better FSH and LH response to the LHRH is achieved during treatment which results in a increase in testosterone production but not so of estradiol. The size of the testicles as well as the amount of pubic hair increased in all cases, although fertility was only achieved in one patient, who also showed the best testicular response. We may conclude that treatment with intermittent infusion of LHRH is an important innovation although only partially successful since there are resistant cases and the final outcome is not better than with other methods.