Diagnóstico diferencial de adenoma folicular y carcinoma papilar de tiroides mediante variables cariométricas. Matanzas 2013-2016 / Differential diagnosis of thyroidal follicular adenoma and papillary carcinoma by means of karyometric variables. Matanzas 2013-2016

RESUMEN Introducción: los carcinomas diferenciados de tiroides se originan en el epitelio folicular. De ellos el carcinoma papilar muestra una mayor incidencia. Una variante del mismo es la folicular, que en ocasiones muestra un patrón arquitectural que imita a un adenoma folicular. Objetivo: contribuir al diagnóstico diferencial entre el carcinoma papilar variante folicular y el adenoma folicular de tiroides, utilizando variables cariométricas de las células foliculares. Materiales y métodos: se aplicaron técnicas morfométricas a muestras de biopsias de tiroides con carcinoma papilar variante folicular y adenoma folicular, así como a muestras sin patología, en el período comprendido de enero de 2013 a diciembre de 2016, obtenidas en el Hospital Universitario Clínico Quirúrgico Comandante Faustino Pérez Hernández, de Matanzas. Las técnicas aplicadas se basaron en las variables cuantitativas: área, perímetro y factor de forma nuclear de las células foliculares. Los resultados se expresaron en porcentajes; la media aritmética como medida de tendencia central; desviación típica, incluyéndose el cálculo de los valores máximo, mínimo y recorrido para cada variable comprendida en el estudio, reflejados en tablas y gráficos realizados a través del software Microsoft Office Excel. Resultados: se obtuvieron valores elevados de área y perímetro nuclear de las células foliculares del carcinoma papilar variante folicular con relación al adenoma folicular, mientras que el factor de forma no arrojó resultados significativos para la diferenciación de dichas enfermedades tiroideas. Conclusiones: la aplicación de técnicas morfométricas a variables cariométricas en el tiroides, para el diagnóstico diferencial entre el carcinoma papilar variante folicular y el adenoma folicular, ofrece resultados aplicables en estudios histopatológicos (AU).

ABSTRACT Introduction: differentiated thyroid carcinomas are originated in the follicular epithelium. Of them, the papillary carcinoma shows higher incidence. Follicular carcinoma, one of its variants, occasionally shows an architectural pattern imitating a follicular adenoma. Objective: to contribute to the differential diagnosis between the papillary carcinoma, follicular variant, and thyroid follicular adenoma, using karyometric variables of follicular cells. Materials and methods: morphometric techniques were applied to samples of biopsies of thyroids with papillary carcinoma, follicular variant, and follicular adenoma, and also to samples without any pathology, in the period from January 2013 to December 2016, gathered in the University Hospital Comandante Faustino Perez, of Matanzas. The applied techniques were based on quantitative variables: area, perimeter and nuclear form factor. Results were expressed in percentages; the arithmetic median as measure of central tendency; typical deviation, including the calculation of maximal, minimal values and the course for each variable included in the study, were drawn in tables and graphics using Microsoft Office Excel software. Results: highs values of area and nuclear perimeter of the follicular cells of the papillary carcinoma, follicular variant, were obtained, while the shape factor did not show significant results for those thyroidal diseases differentiation. Conclusions: the application of morphometric techniques to karyometric variables in the thyroids, for the differential diagnosis between the papillary carcinoma, follicular variant, in follicular carcinoma, offers results that can be applied in histopathological studies (AU).

Diabetes mellitus vs diabetes insípida y un factor común: la poliuria. Presentación de un caso / Diabetes mellitus versus diabetes insipidus and a common factor: polyuria. Case presentation

La diabetes mellitus es una enfermedad crónica no trasmisible muy frecuente en la ciudad de Matanzas, se presenta en cualquier grupo etáreo, siendo tipo I o tipo II. En la diabetes tipo I, el cuerpo no produce insulina. En la diabetes tipo II, la más común, el cuerpo no produce o no usa la insulina adecuadamente. Sin suficiente insulina, la glucosa permanece en la sangre, provocando múltiples complicaciones tanto agudas como crónicas. La diabetes insípida es un trastorno poco común del metabolismo del agua. Esto quiere decir que el balance entre la cantidad de agua o líquido que usted toma no corresponde con el volumen de excreción urinaria. Es causada por una falta de respuesta o una respuesta deficiente a la hormona antidiurética vasopresina. Esta hormona controla el balance hídrico mediante la concentración de orina. Los pacientes con diabetes insípida orinan mucho, por lo cual necesitan beber bastantes líquidos para reemplazar los que pierden. Se presenta un paciente de 45 años con antecedentes de salud que debutó con una diabetes insípida y un año más tarde con una diabetes mellitus tipo II concomitando ambas, corroborándose por los complementarios correspondientes y mejorando con tratamiento (AU).

Diabetes mellitus is a non-transmissible chronic disease, very frequent in the city of Matanzas, which is present in any age group, and is classified as type I and type II. In the type I diabetes, the body does not produce insulin. In the type II diabetes, the most common one, the body does not produce or does not use it effectively. Without enough insulin, glucose remains in the blood, causing several complications, both acute and chronic. The diabetes insipidus is a few common disorder of the water metabolism. That means that the balance between the quantity of water or any other fluid someone drinks does not coincide with the volume of the urinary excretion. It is due to a lack of answer or a deficient answer to the anti-diuretic hormone vasopressin. This hormone controls the water balance through the urine concentration. The patients with diabetes insipidus urinate a lot, so they need to drink many liquids to replace those they lose. It is presented the case of a patient aged 45 years, with health antecedents, that debuted with diabetes insipidus and a year later with a concomitant type II diabetes mellitus. The complementary tests confirmed that and the patient got better with the treatment (AU).

Central diabetes insipidus: clinical profile that suggests organicity in Peruvian children: Lima - Peru 2001-2013.

BACKGROUND: Central diabetes insipidus (CDI) is a heterogeneous disease caused by arginine vasopressin deficiency; its management implies a profound understanding of the pathophysiology and the clinical spectrum. The aim of the study was to describe the clinical characteristics that indicate organicity in children and adolescents with central diabetes insipidus treated at the Department of Endocrinology from The Child Health's Institute during 2001 to 2013. METHODS: Cross-sectional, retrospective study. 79 cases of patients diagnosed with CDI (51 males and 28 females) from 1 month to 16 years of age were reviewed. For the descriptive analysis, measures of central tendency and dispersion were used; groups of organic and idiopathic CDI were compared using χ2-test and t-test. A p-value<0.05 was considered significant. RESULTS: The average age of patients was 8.1±4.2 years. Organic causes were intracranial tumors, 44 (55.7%), Langerhans cell histiocytosis (LCH), 11 (13.9%) and cerebral malformations in 7 (8.9%) patients, while the idiopathic group was 14 (17.7%) patients. Regarding clinical characteristics suggestive of organicity, headache (p=0.02) and visual disturbances (p=0.01) were found statistically significant. The anterior pituitary hormonal abnormalities were documented in 34 (52.3%) organic CDI patients. Furthermore, we did not find a significant difference in the average daily dose of desmopressin between patients with permanent vs. transitory CDI (0.81±0.65 vs. 0.59±0.62; p=0.363). CONCLUSIONS: The main clinical features suggestive of organicity in pediatric patients with central diabetes insipidus were headache and visual disturbances; furthermore, anterior pituitary hormonal abnormalities suggest an underlying organic etiology.

Central Diabetes insipidus in a cat

Background: Diabetes insipidus is a rare disease in cats with few reports in the scientifi c literature. It has two major forms: Central Diabetes Insipidus (CDI); characterized by decreased secretion of antidiuretic hormone (ADH), and Nephrogenic Diabetes Insipidus (NDI); characterized by decreased ability to concentrate urine because of resistance to ADH. The diagnosis is based on excluding diseases with polydipsia/polyuria, the water deprivation test and response to desmopressin. This case report describes Central Diabetes Insipidus in a domestic cat, as well as its response to desmopressin administered intranasally. Case: A 2-year old, male cat of non-defi ned breed and castrated was seen due to a history of polyuria and polydipsia (PU/ PD) that arose after allegedly ingesting thorns that got stuck to its body while going out of the house. Physical examination revealed an active well-fed animal with mild dehydration and persistent paradoxical ischuria. The complementary tests performed: abdominal ultrasound, blood test, urinalysis, serum urea, creatinine, glucose, cortisol, total T4, Total T3 and vasopressin, were within the reference values, except for urinary density and T4 that were below the standard. Based on the laboratory results, conditions compatible with PU and PD symptoms were excluded; however, despite normal vasopressin levels, diabetes insipidus was not ruled...(AU)

Central Diabetes insipidus in a cat

Background: Diabetes insipidus is a rare disease in cats with few reports in the scientifi c literature. It has two major forms: Central Diabetes Insipidus (CDI); characterized by decreased secretion of antidiuretic hormone (ADH), and Nephrogenic Diabetes Insipidus (NDI); characterized by decreased ability to concentrate urine because of resistance to ADH. The diagnosis is based on excluding diseases with polydipsia/polyuria, the water deprivation test and response to desmopressin. This case report describes Central Diabetes Insipidus in a domestic cat, as well as its response to desmopressin administered intranasally. Case: A 2-year old, male cat of non-defi ned breed and castrated was seen due to a history of polyuria and polydipsia (PU/ PD) that arose after allegedly ingesting thorns that got stuck to its body while going out of the house. Physical examination revealed an active well-fed animal with mild dehydration and persistent paradoxical ischuria. The complementary tests performed: abdominal ultrasound, blood test, urinalysis, serum urea, creatinine, glucose, cortisol, total T4, Total T3 and vasopressin, were within the reference values, except for urinary density and T4 that were below the standard. Based on the laboratory results, conditions compatible with PU and PD symptoms were excluded; however, despite normal vasopressin levels, diabetes insipidus was not ruled...

Indicadores Sociodemográficos e Capacidade Funcional de Idosos Diabéticos / Sociodemographic Indicators and Functional Capacity of Diabetic Elderlies

Este estudo exploratório teve como objetivomensurar os indicadores sociodemográficos e a capacidadefuncional de idosos diabéticos. Material e Métodos: Daamostra, participaram cinquenta idosos. A coleta de dadosfoi realizada mediante entrevista estruturada, contemplandoquestões pertinentes ao objeto de estudo. A análise dosdados foi efetivada numa abordagem quantitativa.Resultados: A maioria dos idosos (54,0%) encontrava-se nafaixa etária de 75 a 79 anos, havendo entre estes umpredomínio de mulheres (64,0%); 96,0% dos idosos possuíamrenda de um a três salários mínimos; 34,0% tinham a doençanum período de até cinco anos; 28,0% já conviviam com oproblema num período de dez a vinte anos; 22,0% já possuíama doença num intervalo de cinco a dez anos. Os demais,8,0% conviviam com a doença há mais de vinte anos. Quantoà condição de saúde e desempenho físico, 96,0%expressavam enfermidades coexistentes com o diabetes,20,0% deles evidenciaram baixo nível de capacidade física,64,0% capacidade moderada e 16,0% capacidade física denível avançado. No tocante ao desempenho cognitivo dosidosos, 2,0% possuíam déficit cognitivo grave, 22,0%apresentavam desempenho cognitivo limítrofe. Na avaliaçãodo estado afetivo identificou-se que 44,0% dos idososexpressavam sintomas depressivos. Conclusão: os achadosapontam a necessidade de incorporação do conceito decapacidade funcional como norteador das ações dosprofissionais de saúde junto aos idosos diabéticos...

This exploratory study aimed to measure thesociodemographic indicators and functional capacity ofdiabetic elderlies. Material and Methods: Fifty aged peopleparticipated of the sample. Data collection was done throughstructured interview, addressing relevant issues to the objectof study. Data analysis was made by means of a quantitativeapproach. Results: The majority of the aged people (54.0%)were in age group 75-79 years, in which the female genderprevailed (64.0%); 96.0% of the elderly had income betweenone and three minimum wages. Regarding the time living withdiabetes, 34.0% had had the disease during a period of fiveyears or less, 28.0% had been living with the problem for tento twenty years and 22.0% had had the disease for five toten years. The remaining 8.0% had been living with diabetesfor more than twenty years. With regards to health conditionand physical performance, 96.0% expressed diseasescoexisting with diabetes, 20.0% showed low levels ofphysical ability, 64.0% revealed medium capacity level and16.0% advanced physical capacity level. Regarding theelderly’s cognitive performance, 2.0% had severe cognitiveimpairment and 22.0% had limitrophe cognitive performance.In the affective state evaluation, 44.0% of the elderly wereidentified to express depressive symptoms. Conclusion:These findings indicate the need to incorporate the conceptof functional capacity as a guide for health professionals’actions towards the care of diabetic aged people...

Empty sella syndrome, panhypopituitarism, and diabetes insipidus.

We present an 18-month-old girl with short stature, obesity, panhypopituitarism, diabetes insipidus, and visual defects. Postmortem examination revealed brain atrophy due to a diffuse encephalopathy, numerous calcified neurons in cerebral cortex, deep telencephalic and diencephalic nuclei, diffuse neuronal necrosis in hypothalamic nuclei, moderate atrophy of optic nerves, very thin hypophyseal stalk, and empty sella with the hypophysis compressed to the dorsal aspect of the concavity. Our hypothesis is that the presence of an empty sella in a child with hypophyseal-hypothalamic abnormalities should alert physicians to the existence of hypothalamic lesions secondary to a perinatal insult. We discuss the possible pathogenesis of these findings as well as lines of evidence available in the literature.

Diabetes insipidus secondary to Wegener's granulomatosis: report and review of the literature.

We describe a 51-year-old woman with Wegener's granulomatosis who developed diabetes insipidus 7 months after the onset of her granulomatous disease and despite apparently good clinical response to prednisone and trimethoprim-sulphametoxazole treatment. A brain computerized tomographic scan taken soon after the onset of polyuria disclosed an enlarged pituitary gland that completely returned to its normal size after 5 months of cyclophosphamide therapy. We review 6 other published cases of diabetes insipidus secondary to Wegener's granulomatosis and discuss the potential pathogenetic mechanisms of this rare combination.