Prevalence, risk factors and evolution of diabetes mellitus after treatment in primary aldosteronism. Results from the SPAIN-ALDO registry.

PURPOSE: To evaluate the prevalence, risk factors and evolution of diabetes mellitus (DM) after targeted treatment in patients with primary aldosteronism (PA). METHODS: A retrospective multicenter study of PA patients in follow-up at 27 Spanish tertiary hospitals (SPAIN-ALDO Register). RESULTS: Overall, 646 patients with PA were included. At diagnosis, 21.2% (n = 137) had DM and 67% of them had HbA1c levels < 7%. In multivariate analysis, family history of DM (OR 4.00 [1.68-9.53]), the coexistence of dyslipidemia (OR 3.57 [1.51-8.43]) and advanced age (OR 1.04 per year of increase [1.00-1.09]) were identified as independent predictive factors of DM. Diabetic patients were on beta blockers (46.7% (n = 64) vs. 27.5% (n = 140), P < 0.001) and diuretics (51.1% (n = 70) vs. 33.2% (n = 169), p < 0.001) more frequently than non-diabetics. After a median follow-up of 22 months [IQR 7.5-63.0], 6.9% of patients developed DM, with no difference between those undergoing adrenalectomy and those treated medically (HR 1.07 [0.49-2.36], p = 0.866). There was also no significant difference in the evolution of glycemic control between DM patients who underwent surgery and those medically treated (p > 0.05). CONCLUSION: DM affects about one quarter of patients with PA and the risk factors for its development are common to those of the general population. Medical and surgical treatment provides similar benefit in glycemic control in patients with PA and DM.

Ecografía clínica en la enfermedad tromboembólica venosa / Clinical ultrasonography in venous thromboembolism disease

La ecografía clínica se ha desarrollado exponencialmente en la última década en distintos ámbitos de la medicina. De igual manera que ha ocurrido en otros campos de actuación de la medicina interna, su uso se ha implantado en la enfermedad tromboembólica venosa, tanto en la trombosis venosa profunda como en la embolia pulmonar. En esta revisión se repasan las técnicas para el diagnóstico, tanto de la trombosis venosa profunda a través de la ultrasonografía por compresión, como de la ecografía multiórgano que incluye la ultrasonografía por compresión, la ecografía pulmonar en busca de infartos pulmonares y la ecocardioscopia para la detección de dilatación y/o disfunción del ventrículo derecho, para el diagnóstico de la embolia pulmonar. Además, se plantean los escenarios clínicos más frecuentes en los que puede ser de ayuda la ecografía clínica en la vida real, así como sus limitaciones y la evidencia existente

The use of clinical ultrasonography has grown exponentially in the past decade in various medical settings. As with other areas of activity in the field of internal medicine, clinical ultrasonography has been implemented in venous thromboembolism disease, both in deep vein thrombosis and pulmonary embolism. In this review, we cover the diagnostic techniques, both for deep vein thrombosis through compression ultrasonography and for multiorgan ultrasonography, which include compression ultrasonography, pulmonary ultrasonography in the search for pulmonary infarctions and echocardiography for detecting dilation and right ventricular dysfunction for the diagnosis of pulmonary embolism. We also establish the most common clinical scenarios in which clinical ultrasonography can be of assistance in actual clinical practice, as well as its limitations and current evidence

Clinical ultrasonography in venous thromboembolism disease. / Ecografía clínica en la enfermedad tromboembólica venosa.

The use of clinical ultrasonography has grown exponentially in the past decade in various medical settings. As with other areas of activity in the field of internal medicine, clinical ultrasonography has been implemented in venous thromboembolism disease, both in deep vein thrombosis and pulmonary embolism. In this review, we cover the diagnostic techniques, both for deep vein thrombosis through compression ultrasonography and for multiorgan ultrasonography, which include compression ultrasonography, pulmonary ultrasonography in the search for pulmonary infarctions and echocardiography for detecting dilation and right ventricular dysfunction for the diagnosis of pulmonary embolism. We also establish the most common clinical scenarios in which clinical ultrasonography can be of assistance in actual clinical practice, as well as its limitations and current evidence.

Metalbumina sérica parámetro pronóstico en las pancreatitis agudas / Serum methealbumin: prognosis factor of acute pancreatitis

Objetivos. Evaluar la determinación de la metalbúminia sérica en el pronóstico de las pancreatitis agudas. Casuística. Métodos. Se estudian 101 sujetos; 35 controles normales y 66 pacientes diagnosticados de pancreatitis agudas, de los que 40 eran de tipo leve (edematosas) y 26 graves (necrótico-hemorrágicas). La etiología en las formas leves era: alcohólica 6 casos, litiásica 18 casos e idiopática 16 casos y en las formas graves: 10 casos alcohólicas, 13 litiásicas y 3 idiopáticas. Como patrón pronóstico Standard se utilizó la clasificación de Ranson. La metalbúminia sérica se determinó por el método de Chong. Se realizaron determinaciones precoces (primeras 24 horas), intermedias entre 24-48 horas y tardías entre 3-7 días. Resultados. Hubo diferencias significativas entre las concentraciones séricas de metalbúmina en los normales y pancreatitis aguadas en todas las fases evolutivas. No hubo diferencias significativas en las determinaciones precoces de las formas leves y graves, si hubo significación estadística en las fases intermedias y tardías de ambos tipos de pancreatitis agudas. Conclusiones. La metalbúmina es un parámetro de fácil realización y bajo costo para el diagnóstico diferencial de las pancreatitis agudas, aunque la significación estadística se consigue a partir de las 24 horas

Objetives: To asses the determination of serum methealbumin in the prognosis of acute pancreatitis. Casuistry Methods. A total of 101 individuals were studied, 35 controls and 66 patients diagnosed as having acute pancreatitis. Forty of them had edematous pancreatitis and 26, necrotizing or hemorrhagic pancreatitis. According to their etiology, in the mild cases, pancreatitis was alcoholic (6), with lithiasis (18) and idiopathic (16), while in the severe cases it was alcoholic (10), with lithiasis (13) and idiopathic (3). Ranson-s criteria were used as a prognosis standard pattern. Chong method was used for the determination of serum methemalbumin. Early determinations in the first 24 hours, intermediate (24 to 48 hours), and late ones (3 to 7 days) were carried out.Results. Concentrations of serum methemalbumin in the control group were 0.06±0.02 mg/dl. Concentrations in mild acute pancreatitis were: Early determination: 0.43±0.07 mg/dl, Intermediate determination: 0,46±0.09 mg/dl, Late determination: 0.81±1,30 mg/dl. Serum concentrations in severe acute pancreatitis were: Early determination: 0.65±0.30 mg/dl, Intermediate determination: 2.42±0.83 mg/dl, Late determination: 4,02±1.43 mg/dl. There were significant differences between the concentrations of serum methemalbumin found in the controls and those found in the cases of acute pancreatitis in all its evolutionary stages. There were no significant differences in the early determinations carried out in the mild and severe cases of pancreatitis, although there were significant differences in the early determinations carried out in the mild and severe cases of pancreatitis, although there were significant differences in the intermediate and late stages of both kids of acute pancreatitis. Conclusions. Methemalbumin is an easy and low-cost parameter in order to carry out a differential diagnosis of acute pancreatitis although its statistical significance is achieved after 24 hours

Gastrostomía percutánea endoscópica complicada con Fascitis necrotizante / Necrotizing fasciitis after percutaneous gastrostomy

La indicación de la gastrostomía endoscópica percutánea es cada día más frecuente debido en parte a la importancia creciente que han adquirido los cuidados paliativos en la actualidad. Debemos conocer las complicaciones que pueden aparecer en estos pacientes. Se presenta un caso de fascitis necrotizante de pared abdominal en un paciente portador de gastrostomía (AU)

Nowadays the necessity of percutaneous gastrostomy is increasing owed to the major importance of palliatives support in several patients. Its necessary to know the complications of this proceeding. We present a patient with abdominal wall necrotizing fasciitis complicating percutaneous endoscopic gastrostomy (AU)