Relationship of thyroid hormone levels and cardiovascular events in patients with type 2 diabetes.

Alterations in thyroid hormone levels are found associated with inflammation in patients with non-thyroidal illness (NTIS) and are common in patients with type 2 diabetes mellitus (T2DM). Inflammation has also been linked with development of cardiovascular events (CVE) in T2DM. Our objective was to assess whether thyroid hormone abnormalities typical of NTIS in patients with T2DM are related to inflammation and CVE. This was a cross-sectional study of 140 subjects; 70 with T2DM and 70 as a control group paired by age, sex and body mass index (BMI). We recorded age, sex, BMI, waist/hip ratio, diabetes duration, HbA1c, CVE history, serum amyloid A (SAA), TSH, total (T) and free (F) T4 and T3, reverse T3 (rT3) and TT3/rT3 ratio. Patients with T2DM had lower levels of TT4 (p = 0.012), TT3 (p < 0.001), FT3 (p < 0.001) and TT3/rT3 (p = 0.002). They also showed higher FT4 (p < 0.001) and similar TSH levels (p = 0.627) compared to the control group. SAA levels correlated positively with rT3 (r = 0.45; p < 0.001) and inversely with TT3/rT3 (r = -0.38; p = 0.001). Patients with T2DM and history of CVE had higher rT3 (p = 0.006) and lower TT3/rT3 (p = 0.002), along with higher SAA levels (p = 0.002) than patients without this characteristic. Multiple logistic regression showed that factors independently associated with CVE were older age (OR = 1.159, 95 % CI 1.011-1.329), male sex (OR = 4.391, 95 % CI 1.081-17.829) and higher TT3/rT3 (OR = 0.993, 95 % CI 0.987-0.999). We have confirmed the presence of NTIS in T2DM. We also showed that thyroid hormone abnormalities are associated to inflammatory activity and to CVE in these patients.

Antioxidant capacity, quality, and anthocyanin and nutrient contents of several peach cultivars [Prunus persica (L.) Batsch] grown in Spain.

Antioxidant capacity, quality, and anthocyanin and nutrient contents of 106 peach cultivars from different breeding programs were evaluated at the Estació Experimental de Lleida, IRTA (Catalonia, Spain), during two growing seasons (2010 and 2011). High variability was found among cultivars within each quality trait, where different cultivars were scored as the best and the worst. For example, a 5-fold range (2.17-12.07 g of malic acid L⁻¹), 6-fold range (144.20-711.73 µg of Trolox g⁻¹ of FW), and 11-fold range (0.70-11.43 mg of cyanidin-3-glucoside kg⁻¹ of FW) were observed in titratable acidity, relative antioxidant capacity, and anthocyanin content, respectively. The breeding program within each fruit type (melting peach, nectarine, and flat peach) and qualitative pomological traits also had significant effects on the quality. Nevertheless, each breeding program had specific characteristics that distinguished it from the others. Even so, within each breeding program, there is high variability among cultivars. Therefore, growers should not base their strategy exclusively on the choice of breeding program. Principal component analysis for each fruit type (melting peach, nectarine, nonmelting peach, and flat peach) allowed a selection of a set of cultivars from different breeding programs with the highest quality performance. For example, cultivars such as 'Azurite', 'IFF 1230', 'Amiga', 'Fire Top', 'African Bonnigold', 'Ferlot', 'Mesembrine', and 'Platifirst' had higher sweetness and flavor compared to the others. Therefore, this study could help breeders to make decisions for the selection of new cultivars able to improve the quality features of fruit intake, technicians to know better quality performance of peach cultivars, and consumers to meet their expectations for fruit with high health benefits and a specific taste.

Pharmacokinetics and pharmacodynamics of a new ACT formulation: Artesunate/Amodiaquine (TRIMALACT) following oral administration in African malaria patients.

A new fixed-dose combination of artesunate (AS) plus amodiaquine (AQ) (TRIMALACT) was recently developed for the treatment of uncomplicated falciparum malaria. The originality of this combination lies in its galenic formulation which consists of a three-layer tablet with two layers containing each of the active ingredients, i.e. AS and AQ, and these are separated by a middle layer containing an antioxidant compound. To evaluate the efficacy and tolerability of this combination, adults with uncomplicated malaria received three administrations of two tablets (100:300 mg AS/AQ) in a 24-h interval, in Democratic Republic of Congo. Parasitemia and fever were measured and the plasma levels of parent compounds and metabolites [dihydroartemisinin (DHA) and monodesethylamodiaquine (MdAQ)] were determined by high-performance liquid chromatography. In addition, we determined the prevalence of molecular markers of resistance to chloroquine (CQ) and sulfadoxine/pyrimethamine (SP). The AS/AQ combination TRIMALACT demonstrated a good efficacy resulting in an excellent clinical and parasitological response rate of 100% after correction for PCR results. Treatment regimen was well tolerated. The main disposition parameters to AS+AQ were: for DHA, AUC = 632 +/- 475 ng h/ml and Cmax = 432 +/- 325 ng/ml, and for MdAQ = 14268 +/- 4114 ng h/ml and Cmax = 336 +/- 225 ng/ml (mean +/- standard deviation). Parasite genotyping show high frequencies of molecular SP- and CQ-resistance markers with more 80% of the samples showing more than three mutations linked to SP resistance and 93.48% carrying parasite with the CQ-resistant haplotype. This study shows that the AS/AQ combination TRIMALACT is safe and effective in the treatment of highly drug-resistant falciparum malaria.

[Association of adenocarcinoma of esophagus and breast cancer in a male with Madelung' disease]. / Asociación de adenocarcinoma de esófago y cáncer de mama en un varón con enfermedad de Madelung.

The development of a cancer of the esophagus in women who previously had received radiotherapy for breast cancer is a known although infrequent event. The risk of apparition of the second neoplasia is greater in women who survive at least ten years after the exposition to the radiation. Squamous cell carcinoma is the histological subtype more frequent. We report a case of adenocarcinoma of the esophagus in a man diagnosed of benign symmetrical lipomatosis (Madelung' disease), who had received adjuvant radiotherapy three years before for breast cancer.

Microhamartomas hepáticos (complejos de Von Meyenburg) / Multiple bile-duct hamartomas (Von Meyemburg complexes)

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Asociación de adenocarcinoma de esófago y cáncer de mama en un varón con enfermedad de Madelung / Association of adenocarcinoma of esophagus and breast cancer in a male with Madelung´ disease

La aparición de un cáncer de esófago en mujeres que previamente han recibido radioterapia como tratamiento de un cáncer de mama es un hecho conocido aunque poco frecuente. El riesgo de aparición de la segunda neoplasia es mayor cuando han transcurrido diez o más años desde la exposición a la radiación. La estirpe histológica de la neoplasia de esófago más frecuente es la de carcinoma de células escamosas. Se presenta un caso de adenocarcinoma de esófago en un varón, diagnosticado de lipomatosis bilateral simétrica o enfermedad de Madelung, que recibió radioterapia tres años antes por presentar un cáncer de mama

The development of a cancer of the esophagus in women who previously had received radiotherapy for breast cancer is a known although infrequent event. The risk of apparition of the second neoplasia is greater in women who survive at least ten years after the exposition to the radiation. Squamous cell carcinoma is the histological subtype more frequent. We report a case of adenocarcinoma of the esophagus in a man diagnosed of benign symmetrical lipomatosis (Madelung’ disease), who had received adjuvant radiotherapy three years before for breast cancer

[Needle-knife sphincterotomy for biliary access: a prospective study]. / Esfinterotomía de aguja como técnica de acceso a la vía biliar: estudio prospectivo.

OBJECTIVE: Needle-knife sphincterotomy (NKS) is used to achieve biliary access when routine cannulation methods have been unsuccessful. The aim of this study was to analyze the results of NNS in patients with an inaccessible common bile duct (difficult cannulation) using standard techniques in endoscopic retrograde cholangiopancreatography and the factors associated with the success of this procedure and complications. MATERIAL AND METHODS: We performed a prospective study of 72 patients who underwent NKS performed by the same endoscopist (J.E.) because of difficult cannulation of the common bile duct between January 1998 and December 2004. The results were analyzed in terms of successful biliary access, whether this was achieved in one or more sessions, its possible association with the underlying disease, and the incidence and severity of complications. RESULTS: Seventy-two NKS were performed from a total of 1062 sphincterotomies (6.7%). A total of 77.7% of the patients underwent prior implantation of a pancreatic prosthesis (NKS-PP). The final diagnosis was: choledocholithiasis (31.9%), cancer of the pancreas (16.6%), cholangiocarcinoma (13.8%), benign stenosis (8.3%), dysfunction of the sphincter of Oddi (6.9%), normal (6.9%), and miscellaneous (13.8%). Cannulation was successful in 87.5% (63/72), and was achieved in the first session in 73% (46/63). Biliary access was achieved in 72.7% of patients (16/22) with biliopancreatic neoplasms versus 94% (47/50) of those with other diagnoses (p = 0.03). Eleven patients (15.2%) presented 12 complications (16.6%) (6 pancreatitis, 4 cholangitis, 1 papillary hemorrhage, and 1 portal vein filling). The use of a pancreatic prosthesis was related to a higher success rate and significantly fewer complications (p = 0.03). CONCLUSIONS: NKS-PP can be a safe procedure in patients with difficult cannulation of the common bile duct. The presence of biliopancreatic neoplasm is a risk factor for failure to achieve biliary access compared with other diagnoses. The complication rate was similar to that found in other studies. No cases of severe pancreatitis or perforations were found.

Esfinterotomía de aguja como técnica de acceso a la vía biliar: estudio prospectivo / Needle-knife sphincterotomy for biliary access: a prospective study

Objetivo: La esfinterotomía de aguja es una técnica empleada para conseguir el acceso a la vía biliar, cuando los métodos de canulación habituales han fallado. El objetivo ha sido analizar los resultados de la realización de la esfinterotomía de aguja en pacientes con inaccesibilidad a la vía biliar (canulación difícil) mediante técnicas estándar en colangiopancreatografía retrógrada endoscópica, y los factores asociados con el éxito y complicaciones. Material y métodos: Estudio prospectivo que incluye a 72 pacientes entre enero de 1998 y diciembre de 2004, sometidos a esfinterotomía de aguja por canulación difícil de la vía biliar por el mismo endoscopista (J.E.). Los resultados se analizaron respecto al éxito en acceder a la vía biliar, su consecución en una o más sesiones, su posible relación con la enfermedad de base y la incidencia y gravedad de las complicaciones. Resultados: Se realizaron 72 esfinterotomías de aguja de un total de 1.062 esfinterotomías (6,7%). En el 77,7% de los pacientes se colocó previamente una prótesis pancreática. El diagnóstico final fue: coledocolitiasis en el 31,9%; cáncer de páncreas en el 16,6%; colangiocarcinoma en el 13,8%; estenosis benigna en el 8,3%; disfunción del esfínter de Oddi en el 6,9%; normal en el 6,9%, y miscelánea en el 13,8%. Se obtuvo éxito en la canulación en el 87,5% (63/72), y se consiguió en la primera sesión en el 73% (46/63). Se logró el acceso biliar en el 72,7% de los casos (16/22) de neoplasia biliopancreática, frente al 94% (47/50) en pacientes con otros diagnósticos (p = 0,03). Once pacientes (15,2%) presentaron 12 complicaciones (16,6%) (6 pancreatitis, 4 colangitis, 1 hemorragia papilar y 1 relleno de la vena porta). El uso de prótesis pancreática se relacionó con un porcentaje mayor de éxito y menor de complicaciones, alcanzando significación estadística en esta última (p = 0,03).Conclusiones: La esfinterotomía de aguja con prótesis pancreática puede ser un procedimiento seguro en pacientes con canulación difícil de la vía biliar. La presencia de neoplasia biliopancreática es un factor de riesgo de no consecución del acceso biliar frente a otros diagnósticos. La incidencia de complicaciones está en consonancia con otros estudios, y no se han hallado pancreatitis graves ni perforaciones

Objective: Needle-knife sphincterotomy (NKS) is used to achieve biliary access when routine cannulation methods have been unsuccessful. The aim of this study was to analyze the results of NNS in patients with an inaccessible common bile duct (difficult cannulation) using standard techniques in endoscopic retrograde cholangiopancreatography and the factors associated with the success of this procedure and complications. Material and methods: We performed a prospective study of 72 patients who underwent NKS performed by the same endoscopist (J.E.) because of difficult cannulation of the common bile duct between January 1998 and December 2004. The results were analyzed in terms of successful biliary access, whether this was achieved in one or more sessions, its possible association with the underlying disease, and the incidence and severity of complications. Results: Seventy-two NKS were performed from a total of 1062 sphincterotomies (6.7%). A total of 77.7% of the patients underwent prior implantation of a pancreatic prosthesis (NKS-PP). The final diagnosis was: choledocholithiasis (31.9%), cancer of the pancreas (16.6%), cholangiocarcinoma (13.8%), benign stenosis (8.3%), dysfunction of the sphincter of Oddi (6.9%), normal (6.9%), and miscellaneous (13.8%). Cannulation was successful in 87.5% (63/72), and was achieved in the first session in 73% (46/63). Biliary access was achieved in 72.7% of patients (16/22) with biliopancreatic neoplasms versus 94% (47/50) of those with other diagnoses (p = 0.03). Eleven patients (15.2%) presented 12 complications (16.6%) (6 pancreatitis, 4 cholangitis, 1 papillary hemorrhage, and 1 portal vein filling). The use of a pancreatic prosthesis was related to a higher success rate and significantly fewer complications (p = 0.03). Conclusions: NKS-PP can be a safe procedure in patients with difficult cannulation of the common bile duct. The presence of biliopancreatic neoplasm is a risk factor for failure to achieve biliary access compared with other diagnoses. The complication rate was similar to that found in other studies. No cases of severe pancreatitis or perforations were found

[Primary hepatic leiomyosarcoma in a patient with gastric non-Hodgkin lymphoma]. / Leiomiosarcoma hepático primario en un paciente con linfoma no hodgkiniano gástrico.

Primary leiomyosarcoma of the liver is a rare entity and fewer than 100 cases have been reported in the medical literature. Even more unusual is the association with another previous tumour. We report the case of a 84-year-old man who had been treated for a gastric non-Hodgkin lymphoma two years previously. He presented with a painful mass in the right upper abdomen. An ultrasound scan showed a large mass in the right lobe of the liver and chest radiography showed pulmonary metastases. Liver biopsy was performed and immunohistochemical analysis revealed a malignant leiomyosarcoma. We discuss this case and review the available literature.

Lipoma gigante de colon como causa de dolor y masa abdominal / Giant lipoma in colon causing abdominal pain and mass

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[Current status of endoscopic retrograde cholangiopancreatography. What is the effect of the introduction of magnetic resonance cholangiography?]. / Estado actual de la CPRE. Cómo se refleja la introducción de la colangiorresonancia magnética?

AIM: To determine the current status of endoscopic retrograde cholangiopancreatography (ERCP) and the effects of the introduction of magnetic resonance cholangiography (MRC) on ERCP and to evaluate the diagnostic yield of MRC since its introduction in obstructive biliary disease. MATERIAL AND METHODS: We performed a retrospective analysis of the ERCP carried out between January 1998 and December 2000 and of the MRC performed for suspected obstructive biliary disease from May 1999 to December 2000. When both techniques were performed, the diagnostic yield of MRC was evaluated. RESULTS: We performed 927 ERCP. A total of 45.3% of the patients were men. Mean age was 69.2 14.6 years. Treatment was performed on 688 occasions (77%), mainly sphincterotomy (69.9%) and placement of polyethylene (21.8%) or self-expanding (9.9%) prostheses. The number of ERCP performed each year was 261, 330 and 336 in 1998, 1999 and 2000, respectively; of these 76.6%, 80% and 76.9% were therapeutic. MRC was performed in 63 patients with suspected biliary disease. In 27 of 59 patients (45.8%) MRC was sufficient for diagnosis, avoiding the need for ERCP. In the 35 patients in whom both techniques (MRC and ERCP) were performed, the diagnostic yield of MRC compared with that of ERCP was: sensitivity 100%, specificity 50%, positive predictive value 87.1%, negative predictive value 100% and overall value 89%. The cases responsible for the low specificity (all due to choledocholithiases) were analyzed and a significant time lapse was found between the performance of MRC and ERCP (range: 7-35 days) during which choledocholithiasis probably resolved spontaneously. CONCLUSIONS: a) Contrary to what could be expected, the number of ERCP seems to be increasing with a high percentage of endoscopic treatment; b) Because of its diagnostic sensitivity, MRC is the ideal technique for eliminating the need for diagnostic ERCP, thus allowing greater development of the therapeutic aspect of ERCP.

Brain mitochondrial complex I inactivation by oxidative modification.

In vitro oxidation of the brain mitochondrial complex I by the hydroxyl radical generating system ascorbate/Fe(III)/O(2) has been carried out. Complex I inactivation, by oxidation, has been studied using a method based on the resolution of proteins by blue native polyacrylamide gel electrophoresis (BN-PAGE), followed by total protein quantification by staining with Coomassie brilliant blue, in-gel activity quantification, and quantification of oxidized proteins by labelling with DIG-hydrazide and immunodetection with an anti-DIG-AP. Quantification was carried out by densitometry procedure. Our results show that oxidation is a continuous process, increasing rapidly at the beginning, reaching a plateau after 8 h of incubation. There is practically no inactivation until a threshold value of damage is reached. Below this, the complex activity is resistant to the aggression of oxygen-reactive substances and free radicals, but once the threshold value is passed, activity is lost rapidly.

[Multiple hepatic focal nodular hyperplasia: its presentation in childhood and atypical evolution]. / Hiperplasia nodular focal múltiple hepática: presentación en la infancia y evolución atípica.

Multiple focal nodular hyperplasia is an uncommon benign liver tumor although its incidence has been increasing in the last few years. A case of focal nodular hyperplasia in a young woman is described, which was discovered in infancy and which presented two nodules in each lobe. The diagnosis was subsequently confirmed by large surgical biopsy. Conservative therapy was given for 16 years during which time there was progressive tumor growth, increase of pain and cholestatic enzymes. The unusual presentation this benign lesion may have, a strategy for its diagnosis and the generally conservative management that is currently favored are discussed.

[Parkinson disease of juvenile onset with systemic lupus erythematosus in a pre-symptomatic stage]. / Enfermedad de Parkinson de inicio juvenil con lupus eritematoso sistémico en estadio presintomático.

INTRODUCTION: Parkinson's disease of juvenile onset is known to be rarely seen in clinical neurology. Occasionally it may be secondary to other pathological processes which have to be excluded by investigation of such cases, since the clinical, therapeutic and prognostic significance varies considerably depending on whether the condition is idiopathic or secondary. CLINICAL CASE: We present the case of a patient whose illness started when she was 16 years old. She complained of rigidity, tremor and akinesia. Her condition was studied to find whether the syndrome was secondary. Thus, on four occasions, at annual visits during a period of five years, immunological changes suggestive of systemic lupus erythematous were observed. Neuroimaging, magnetic resonance and computerized axial tomography studies were completely normal on all four occasions over the five years during which the patient had annual follow-up reviews. CONCLUSION: We considered whether the rigidity-akinesia-tremor syndrome might have been secondary to systemic lupus erythematous, due to a probable pathological focus of cerebral vasculitis, in this clinical case which we report.

Prognosis in acute renal failure of septic origin: a multivariate analysis.

The goal of the present study was to identify variables associated with the outcome of patients with acute renal failure (ARF) of septic origin, using multivariate analysis. The records of 168 patients were reviewed retrospectively and a crude mortality of 74% was found. Both univariate as well as multivariate analysis demonstrated an association between mortality and variables which depended on patient related factors. These included age over 60 years and several underlying diseases such as pneumonia, peritonitis, and organ dysfunction. Only one variable (late oliguria) related to the ARF itself. Thus, outcome seems related to underlying disease more than to severity of ARF.