[Role of chromoendoscopy in colorectal polyps handling]. / Rol de la cromoendoscopía en el manejo de los pólipos colorrectales.

INTRODUCTION AND AIM: Endoscopic polipectomy and its further histopathologic study are current gold standard in diagnosis of colorectal polyps is. It was proposed that colonoscopy with high resolution videoendoscopes with or without magnification combined with indigo carmin dye (ICD) could distinguish between adenomatous and nonadenomatous polyps according to their pit pattern. The aim of this study was to establish sensitivity and specificity of chromoendoscopy with ICD using conventional videoendoscopes and fiber-endoscopes with videocamera, to make a differential diagnosis of polyp histology and their possible role in colon cancer screening. PATIENTS AND METHODS: Step 1: Using previous trial data, the first 20 polyps < = 1 cm was retrospectively correlated with their known histology to determine the pit pattern of each histologic type; this data was used in the step 2 patients. Step 2: 46 patients with colorectal polyps were enrolled in this prospective study. Polyps were sprayed with 0.4% ICD, after that the polyps were sorted into adenomatous or non, they were all removed and submitted for histophatologic evaluation. STATISTICAL ANALYSIS: The chi square method was used. RESULTS: 19 patients were evaluated with videoendoscopes (group 1) and 27 with fiberendoscopes (group 2); in seven cases the pattern of the polyps could not be identified and the patients were excluded. Group 1: coincidence prediction/histology 94.7% (p < 0.0001), sensitivity 100% and especificity 88%. Group 2: coincidence prediction/histology 65.8% (p < 0.05), sensitivity 86% and especificity 60%. CONCLUSIONS: Adenomatous and non-adenomatous polyps can be distinguished by chromoendoscopy with high sensitivity and specificity. However, because fiberendoscopy could ot be identify pit pattern in 15.2% and has a low negative predictive value we do not recommend to use it. Nevertheless, the results obtained with ideo-endoscopes involve potential usefulness in colon cancer screening and possible decrease in their risks and costs.

Rol de la cromoendoscopía en el manejo de los pólipos colorrectales / Role of chromoendoscopy in colorectal polyps handling

INTRODUCTION AND AIM: Endoscopic polipectomy and its further histopathologic study are current gold standard in diagnosis of colorectal polyps is. It was proposed that colonoscopy with high resolution videoendoscopes with or without magnification combined with indigo carmin dye (ICD) could distinguish between adenomatous and nonadenomatous polyps according to their pit pattern. The aim of this study was to establish sensitivity and specificity of chromoendoscopy with ICD using conventional videoendoscopes and fiber-endoscopes with videocamera, to make a differential diagnosis of polyp histology and their possible role in colon cancer screening. PATIENTS AND METHODS: Step 1: Using previous trial data, the first 20 polyps < = 1 cm was retrospectively correlated with their known histology to determine the pit pattern of each histologic type; this data was used in the step 2 patients. Step 2: 46 patients with colorectal polyps were enrolled in this prospective study. Polyps were sprayed with 0.4% ICD, after that the polyps were sorted into adenomatous or non, they were all removed and submitted for histophatologic evaluation. STATISTICAL ANALYSIS: The chi square method was used. RESULTS: 19 patients were evaluated with videoendoscopes (group 1) and 27 with fiberendoscopes (group 2); in seven cases the pattern of the polyps could not be identified and the patients were excluded. Group 1: coincidence prediction/histology 94.7% (p < 0.0001), sensitivity 100% and especificity 88%. Group 2: coincidence prediction/histology 65.8% (p < 0.05), sensitivity 86% and especificity 60%. CONCLUSIONS: Adenomatous and non-adenomatous polyps can be distinguished by chromoendoscopy with high sensitivity and specificity. However, because fiberendoscopy could ot be identify pit pattern in 15.2% and has a low negative predictive value we do not recommend to use it. Nevertheless, the results obtained with ideo-endoscopes involve potential usefulness in colon cancer screening and possible decrease in their risks and costs.

Rol de la cromoendoscopía en el manejo de los pólipos colorrectales. / [Role of chromoendoscopy in colorectal polyps handling]

INTRODUCTION AND AIM: Endoscopic polipectomy and its further histopathologic study are current gold standard in diagnosis of colorectal polyps is. It was proposed that colonoscopy with high resolution videoendoscopes with or without magnification combined with indigo carmin dye (ICD) could distinguish between adenomatous and nonadenomatous polyps according to their pit pattern. The aim of this study was to establish sensitivity and specificity of chromoendoscopy with ICD using conventional videoendoscopes and fiber-endoscopes with videocamera, to make a differential diagnosis of polyp histology and their possible role in colon cancer screening. PATIENTS AND METHODS: Step 1: Using previous trial data, the first 20 polyps < = 1 cm was retrospectively correlated with their known histology to determine the pit pattern of each histologic type; this data was used in the step 2 patients. Step 2: 46 patients with colorectal polyps were enrolled in this prospective study. Polyps were sprayed with 0.4

ICD, after that the polyps were sorted into adenomatous or non, they were all removed and submitted for histophatologic evaluation. STATISTICAL ANALYSIS: The chi square method was used. RESULTS: 19 patients were evaluated with videoendoscopes (group 1) and 27 with fiberendoscopes (group 2); in seven cases the pattern of the polyps could not be identified and the patients were excluded. Group 1: coincidence prediction/histology 94.7

(p < 0.0001), sensitivity 100

and especificity 88

. Group 2: coincidence prediction/histology 65.8

(p < 0.05), sensitivity 86

and especificity 60

. CONCLUSIONS: Adenomatous and non-adenomatous polyps can be distinguished by chromoendoscopy with high sensitivity and specificity. However, because fiberendoscopy could ot be identify pit pattern in 15.2

and has a low negative predictive value we do not recommend to use it. Nevertheless, the results obtained with ideo-endoscopes involve potential usefulness in colon cancer screening and possible decrease in their risks and costs.

Rol de la cromoendoscopía en el manejo de los pólipos colorrectales / Role of chromoendoscopy in colorectal polyps handling

INTRODUCTION AND AIM: Endoscopic polipectomy and its further histopathologic study are current gold standard in diagnosis of colorectal polyps is. It was proposed that colonoscopy with high resolution videoendoscopes with or without magnification combined with indigo carmin dye (ICD) could distinguish between adenomatous and nonadenomatous polyps according to their pit pattern. The aim of this study was to establish sensitivity and specificity of chromoendoscopy with ICD using conventional videoendoscopes and fiber-endoscopes with videocamera, to make a differential diagnosis of polyp histology and their possible role in colon cancer screening. PATIENTS AND METHODS: Step 1: Using previous trial data, the first 20 polyps < = 1 cm was retrospectively correlated with their known histology to determine the pit pattern of each histologic type; this data was used in the step 2 patients. Step 2: 46 patients with colorectal polyps were enrolled in this prospective study. Polyps were sprayed with 0.4% ICD, after that the polyps were sorted into adenomatous or non, they were all removed and submitted for histophatologic evaluation. STATISTICAL ANALYSIS: The chi square method was used. RESULTS: 19 patients were evaluated with videoendoscopes (group 1) and 27 with fiberendoscopes (group 2); in seven cases the pattern of the polyps could not be identified and the patients were excluded. Group 1: coincidence prediction/histology 94.7% (p < 0.0001), sensitivity 100% and especificity 88%. Group 2: coincidence prediction/histology 65.8% (p < 0.05), sensitivity 86% and especificity 60%. CONCLUSIONS: Adenomatous and non-adenomatous polyps can be distinguished by chromoendoscopy with high sensitivity and specificity. However, because fiberendoscopy could ot be identify pit pattern in 15.2% and has a low negative predictive value we do not recommend to use it. Nevertheless, the results obtained with ideo-endoscopes involve potential usefulness in colon cancer screening and possible decrease in their risks and costs.(AU)

[Ethical dilemmas in gastroenterology practice in Latin-American countries: the AIGE survey]. / Dilemas éticos en la asistencia de la gastroenterología en países latinoamericanos: la encuesta AIGE.

A survey sponsored by the Interamerican Association of Gastroenterology (AIGE) related to decision making in conflictive ethical situations in the setting of gastroenterological practice was designed (AJ-JCG). Seven problem-cases with 3 to 5 pre-established and not-excluding answers each, demographic and occupational data were included, by public invitation during 1996-97 AIGE educational activities in La Plata (Argentina), Montevideo (Uruguay) and Santo Domingo (Dominican Republic). Data were inserted in a computerised data base, and chi square, Fischer and Maentel-Henzel tests were used for statistical studies. 118 out of 460 doctors registered to educational activities answered at the survey (25.6%). Mean age was 42 +/- 15 years and 57.6% were male; 48.5% were under 10 years of professional practice and 19.5% were over 20 years. Gastroenterology was the main specialty in 89.8%. Although only 15.2% of participants reported as not having Ethical Committee (EC) in their institutions, the option of consulting was not very frequently selected, except in cases of request about pregnancy interruption in the HCV infected mother (22.9%), inclusion of the young alcoholic cirrhotic man in the waiting list for liver trasplant (17.8%), and the Jehova's Witness conscious patient with bleeding esophageal varices (13.5%). Cases of direct communication to the patient of early colon cancer diagnosis (66.1%), and inclusion of the young end stage alcoholic cirrhotic patient in the waiting list for liver trasplantation (65.2%), had the higher consensus. On the other hand, lower consensus (39%) was seen in the case of variceal bleeding in the encephalopathic Witness of Jehova patient. Differential criterla were observed related to sex: 38% of women versus 14.7% of men (p < 0.01) refuse the interruption of pregnancy to the infected HCV patient because of personal convictions against abortion. In the case of suspected HIV co-infection in the IVD HBsAG + carrier, 46% of women vs. 27.9% of men (p < 0.05) indicate HIV screening test without any explanation to the patient because "he could transmit a fatal disease". In this same case, time from graduation was related to differences in option selection: 80.9% in the group > 20 years of professional exercise asked for patient consent and accepted his decision, versus 52.7 and 27.5% in 0-9 and 10-19 years group respectively (p < 0.05). Usual medical and social worries as communication (truth, informed consent), the autonomic decision of biological death versus the sacrament of life, justice in allocation resources, confidentiality and social concern, abortion, and many other controversies linked to tecno-scientific development, impact the practice of Gastroenterology in latinoamerican countries. However medical answers to ethical dilemmas are not uniform. Although our results ought to be verified by other studies they clearly suggest the needs for systematic incorporation of applicated Ethics in pre and postgraduate Gastroenterology curricula, besides the regular activities of our regional institutions.

Dilemas éticos en la asistencia de la gastroenterología en países latinoamericanos: la encuesta AIGE. / [Ethical dilemmas in gastroenterology practice in Latin-American countries: the AIGE survey]

A survey sponsored by the Interamerican Association of Gastroenterology (AIGE) related to decision making in conflictive ethical situations in the setting of gastroenterological practice was designed (AJ-JCG). Seven problem-cases with 3 to 5 pre-established and not-excluding answers each, demographic and occupational data were included, by public invitation during 1996-97 AIGE educational activities in La Plata (Argentina), Montevideo (Uruguay) and Santo Domingo (Dominican Republic). Data were inserted in a computerised data base, and chi square, Fischer and Maentel-Henzel tests were used for statistical studies. 118 out of 460 doctors registered to educational activities answered at the survey (25.6

). Mean age was 42 +/- 15 years and 57.6

were male; 48.5

were under 10 years of professional practice and 19.5

were over 20 years. Gastroenterology was the main specialty in 89.8

. Although only 15.2

of participants reported as not having Ethical Committee (EC) in their institutions, the option of consulting was not very frequently selected, except in cases of request about pregnancy interruption in the HCV infected mother (22.9

), inclusion of the young alcoholic cirrhotic man in the waiting list for liver trasplant (17.8

), and the Jehovas Witness conscious patient with bleeding esophageal varices (13.5

). Cases of direct communication to the patient of early colon cancer diagnosis (66.1

), and inclusion of the young end stage alcoholic cirrhotic patient in the waiting list for liver trasplantation (65.2

), had the higher consensus. On the other hand, lower consensus (39

) was seen in the case of variceal bleeding in the encephalopathic Witness of Jehova patient. Differential criterla were observed related to sex: 38

of women versus 14.7

of men (p < 0.01) refuse the interruption of pregnancy to the infected HCV patient because of personal convictions against abortion. In the case of suspected HIV co-infection in the IVD HBsAG + carrier, 46

of women vs. 27.9

of men (p < 0.05) indicate HIV screening test without any explanation to the patient because [quot ]he could transmit a fatal disease[quot ]. In this same case, time from graduation was related to differences in option selection: 80.9

in the group > 20 years of professional exercise asked for patient consent and accepted his decision, versus 52.7 and 27.5

in 0-9 and 10-19 years group respectively (p < 0.05). Usual medical and social worries as communication (truth, informed consent), the autonomic decision of biological death versus the sacrament of life, justice in allocation resources, confidentiality and social concern, abortion, and many other controversies linked to tecno-scientific development, impact the practice of Gastroenterology in latinoamerican countries. However medical answers to ethical dilemmas are not uniform. Although our results ought to be verified by other studies they clearly suggest the needs for systematic incorporation of applicated Ethics in pre and postgraduate Gastroenterology curricula, besides the regular activities of our regional institutions.

Lípidos séricos y evaluación antropométrica en adultos jóvenes / Serum lipids and anthropometric evaluation in young adults

Se estudiaron en forma consecutiva y bajo su consentimiento 76 sujetos aparentemente sanos (38 hombres y 38 mujeres no embarazadas), de 18 a 40 años de edad (media 26,7 ñ 4,7) que concurrieron a efectuar un examen prenupcial, para determinar los lípidos séricos y relacionarlos con el sexo, la edad y los resultados de mediciones antropométricas para la evaluación indirecta del estado nutricional. Se les realizó un cuestionario, se obtuvo el peso, la talla, se midieron los perímetros de la muñeca, el tórax, la cintura y la cadera, se obtuvo el pliegue subcutáneo tricipital y subescapular. Se calculó el Indice de Masa Corporal o "body mass index" (BMI), el peso ideal y el peso relativo, el índice cintura/tórax (C/T) y cintura/cadera (C/C), se dosaron la colesterolemia, el HDL-Colesterol y los Triglicéridos por métodos enzimáticos. Se calculó el LDL-Colesterol (Fórmula de Friedewal) y el índice Col/HDL-col. Resultados: 1) Promedios: Col: 180,7 ñ 43,4 mg/dl, HDL-Col: 47,3 ñ 14,3 mg/dl, TG: 81,1 ñ 61,0 mg/dl, LDL-Col: 116,7 ñ 38,0 mg/dl, IR: 4,03 ñ 1,7, BMI: 23,5 ñ 3,5, PR: 102,4 ñ 10,5, C/T: 0,92 ñ 0,07, C/C: 0,80 ñ 0,08, Tri: 17,7 ñ 7,0 mn y Esc: 15,3 ñ 5,5 mn. Se detectó un 18,42 por ciento de los sujetos que tenían criterios BMI y de peso relativo de obesidad. El 30,26 por ciento de la muestra presentó un aumento del Col, un descenso de HDL-Col y un índice Col/HDL-Col elevado, en este último con un franco predominio de los varones. La frecuencia de hipertrigliceridemia fue baja (13,15 por ciento). Los índices antropométricos utilizados (BMI, PR, C/T, C/C) excepto con el Colesterol (que sólo se vinculó al C/C), mostraron una buena correlación con los lípidos séricos. La edad presentó una fuerte asociación con la colesterolemia pero no con el HDL-Col. Hubo diferencias entre sexos para las variables estudiadas, menos para el C/T y el pliegue escapular. No se detectó ninguna persona con C/C bajo (biotipo "fémoro-glúteo o ginoide) e IR elevado, lo cual plantea el interrogante si esta disposición de la grasa del cuerpo no representa una manifestación de "protección" para que no se desarrolle una dislipemia

Lípidos séricos y evaluación antropométrica en adultos jóvenes / Serum lipids and anthropometric evaluation in young adults

Se estudiaron en forma consecutiva y bajo su consentimiento 76 sujetos aparentemente sanos (38 hombres y 38 mujeres no embarazadas), de 18 a 40 años de edad (media 26,7 ñ 4,7) que concurrieron a efectuar un examen prenupcial, para determinar los lípidos séricos y relacionarlos con el sexo, la edad y los resultados de mediciones antropométricas para la evaluación indirecta del estado nutricional. Se les realizó un cuestionario, se obtuvo el peso, la talla, se midieron los perímetros de la muñeca, el tórax, la cintura y la cadera, se obtuvo el pliegue subcutáneo tricipital y subescapular. Se calculó el Indice de Masa Corporal o "body mass index" (BMI), el peso ideal y el peso relativo, el índice cintura/tórax (C/T) y cintura/cadera (C/C), se dosaron la colesterolemia, el HDL-Colesterol y los Triglicéridos por métodos enzimáticos. Se calculó el LDL-Colesterol (Fórmula de Friedewal) y el índice Col/HDL-col. Resultados: 1) Promedios: Col: 180,7 ñ 43,4 mg/dl, HDL-Col: 47,3 ñ 14,3 mg/dl, TG: 81,1 ñ 61,0 mg/dl, LDL-Col: 116,7 ñ 38,0 mg/dl, IR: 4,03 ñ 1,7, BMI: 23,5 ñ 3,5, PR: 102,4 ñ 10,5, C/T: 0,92 ñ 0,07, C/C: 0,80 ñ 0,08, Tri: 17,7 ñ 7,0 mn y Esc: 15,3 ñ 5,5 mn. Se detectó un 18,42 por ciento de los sujetos que tenían criterios BMI y de peso relativo de obesidad. El 30,26 por ciento de la muestra presentó un aumento del Col, un descenso de HDL-Col y un índice Col/HDL-Col elevado, en este último con un franco predominio de los varones. La frecuencia de hipertrigliceridemia fue baja (13,15 por ciento). Los índices antropométricos utilizados (BMI, PR, C/T, C/C) excepto con el Colesterol (que sólo se vinculó al C/C), mostraron una buena correlación con los lípidos séricos. La edad presentó una fuerte asociación con la colesterolemia pero no con el HDL-Col. Hubo diferencias entre sexos para las variables estudiadas, menos para el C/T y el pliegue escapular. No se detectó ninguna persona con C/C bajo (biotipo "fémoro-glúteo o ginoide) e IR elevado, lo cual plantea el interrogante si esta disposición de la grasa del cuerpo no representa una manifestación de "protección" para que no se desarrolle una dislipemia (AU)

Bioética clínica. Parodi, el diabético que rechazó la amputación de su pierna / Clinical bioethics. Parodi, the person with diabetes rejected the amputation of his leg

El caso Parodi representa el análisis bioético a partir de los escritos del fallo judicial sobre una persona con diabetes no insulinodependiente, alcoholista crónico, que rechazó la amputación de su único miembro inferior con gangrena. El juez decidió a favor del respeto de la decisión autónoma del paciente en lo que se refiere a su negativa a una intervención quirúrgica mutilante,"todo ello sin perjuicio de la continuación de las demás medidas terapéuticas adecuadas al estado de salud del paciente y que resguarden el respeto debido a su condición de persona". Si bien se prodigaron los cuidados necesarios, al tiempo el paciente falleció como consecuencia de su patología. La revisión de los hechos médicos, las expresiones del paciente, la opinión de otros miembros del equipo de salud, el dictamen de peritos y las sugerencias del comité hospitalario de ética pusieron en evidencia la colisión entre bienes y valores de aparente similar importancia y magnitud: la beneficencia médica y la autonomía del enfermo, el valor sacro de la vida y la libertad de la persona para decidir por su propio cuerpo (aunque la elección ponga en riesgo la vida). Se discute acerca de determinación terapéutica inusual e irracional, la asistencia a un suicida y el "derecho a morir", no prolongar la agonía, dejar morir, matar y eutanasia

Bioética clínica. Parodi, el diabético que rechazó la amputación de su pierna / Clinical bioethics. Parodi, the person with diabetes rejected the amputation of his leg

El caso Parodi representa el análisis bioético a partir de los escritos del fallo judicial sobre una persona con diabetes no insulinodependiente, alcoholista crónico, que rechazó la amputación de su único miembro inferior con gangrena. El juez decidió a favor del respeto de la decisión autónoma del paciente en lo que se refiere a su negativa a una intervención quirúrgica mutilante,"todo ello sin perjuicio de la continuación de las demás medidas terapéuticas adecuadas al estado de salud del paciente y que resguarden el respeto debido a su condición de persona". Si bien se prodigaron los cuidados necesarios, al tiempo el paciente falleció como consecuencia de su patología. La revisión de los hechos médicos, las expresiones del paciente, la opinión de otros miembros del equipo de salud, el dictamen de peritos y las sugerencias del comité hospitalario de ética pusieron en evidencia la colisión entre bienes y valores de aparente similar importancia y magnitud: la beneficencia médica y la autonomía del enfermo, el valor sacro de la vida y la libertad de la persona para decidir por su propio cuerpo (aunque la elección ponga en riesgo la vida). Se discute acerca de determinación terapéutica inusual e irracional, la asistencia a un suicida y el "derecho a morir", no prolongar la agonía, dejar morir, matar y eutanasia (AU)

[Histopathological and functional study of the kidney in non-insulin dependent diabetes mellitus]. / Estudio histopatológico y funcional del riñón en la diabetes no insulino dependiente.

The histopathological characteristics of the kidney using light microscopy and immunofluorescence studies in samples obtained by renal percutaneous biopsy in 19 women and 7 men with non-insulin dependent diabetes mellitus (NIDDM) (mean of age: 55.07 +/- 9.04 yr and mean of "known" diabetes duration: 7.50 +/- 6.87 yr) were studied. The relationship with age, blood pressure, diabetic retinopathy and other complementary diagnostic methods such as serum creatinine (Cr), creatinine clearance (CrC), renal plasma flow (RPF), proteinuria and filtration fraction (FF) were also determined. Light microscopy studies detected 92.3% of patients with renal lesions of different degrees of severity. The presence and severity of glomerulopathy and arteriolopathy were related to diabetes duration (r: 0.764) and they were related to each other (rs: 0.773). In 2 patients, lesions were not observed and in 11 out of 14 patients with less than 5 yr of diabetes duration, mild lesions were detected. However, the histological changes became worse after that period. The glomerulopathy was also statistically correlated with Cr, CrC, RPF, proteinuria and FF. By immunofluorescence, fibrinogen, IgA and C3 were the most frequent and intense precipitates observed. They increased with diabetes duration and were located predominantly in the wall and the periphery of the glomerules and in renal tubules, suggesting that they originated by trapping. There were no precipitates in the mesenchyma, they were scarce in the interstice, Bowman's capsule and arterioles. Statistical correlation between diabetic histopathological renal changes and retinopathy was found. These results confirm that lesions in the kidney and retina in non-insulin dependent diabetic patients generally appear and evolve in a similar manner. Hypertension was diagnosed in 80.76% of patients, without statistical correlation between blood pressure and renal lesions. This suggests that at the onset, in non-insulin dependent diabetic patients hypertension and nephro-pathy are caused by different and independent pathogenic mechanisms. However, at an end stage, it seems that both situations can influence each other in a way that their evolution becomes more severe. Nephropathy in non-insulin dependent diabetes mellitus displayed scarce clinical signs and poor laboratory evidence except when the renal lesions become too severe. The lack of correlation between renal lesions and patients' age and blood pressure suggests the participation of diabetes at the onset of kidney structural impairment.

Estudio histopatológico y funcional del riñón en la diabetes no insulino dependiente. / [Histopathological and functional study of the kidney in non-insulin dependent diabetes mellitus]

The histopathological characteristics of the kidney using light microscopy and immunofluorescence studies in samples obtained by renal percutaneous biopsy in 19 women and 7 men with non-insulin dependent diabetes mellitus (NIDDM) (mean of age: 55.07 +/- 9.04 yr and mean of [quot ]known[quot ] diabetes duration: 7.50 +/- 6.87 yr) were studied. The relationship with age, blood pressure, diabetic retinopathy and other complementary diagnostic methods such as serum creatinine (Cr), creatinine clearance (CrC), renal plasma flow (RPF), proteinuria and filtration fraction (FF) were also determined. Light microscopy studies detected 92.3

of patients with renal lesions of different degrees of severity. The presence and severity of glomerulopathy and arteriolopathy were related to diabetes duration (r: 0.764) and they were related to each other (rs: 0.773). In 2 patients, lesions were not observed and in 11 out of 14 patients with less than 5 yr of diabetes duration, mild lesions were detected. However, the histological changes became worse after that period. The glomerulopathy was also statistically correlated with Cr, CrC, RPF, proteinuria and FF. By immunofluorescence, fibrinogen, IgA and C3 were the most frequent and intense precipitates observed. They increased with diabetes duration and were located predominantly in the wall and the periphery of the glomerules and in renal tubules, suggesting that they originated by trapping. There were no precipitates in the mesenchyma, they were scarce in the interstice, Bowmans capsule and arterioles. Statistical correlation between diabetic histopathological renal changes and retinopathy was found. These results confirm that lesions in the kidney and retina in non-insulin dependent diabetic patients generally appear and evolve in a similar manner. Hypertension was diagnosed in 80.76

of patients, without statistical correlation between blood pressure and renal lesions. This suggests that at the onset, in non-insulin dependent diabetic patients hypertension and nephro-pathy are caused by different and independent pathogenic mechanisms. However, at an end stage, it seems that both situations can influence each other in a way that their evolution becomes more severe. Nephropathy in non-insulin dependent diabetes mellitus displayed scarce clinical signs and poor laboratory evidence except when the renal lesions become too severe. The lack of correlation between renal lesions and patients age and blood pressure suggests the participation of diabetes at the onset of kidney structural impairment.

Aspectos psicoanalíticos de diabéticos con bomba de infusión de insulina: previsiones para la selección de pacientes / Psychoanalytical aspects of diabetic patients using insulin pump: the selection of patient

Se intenta determinar las consecuencias psíquicas de la idea de colocación de una bomba de insulina, señalar los sentimientos sobre el aparato según los estilos personales y evaluar el empleo preventivo de las consultas psicológicas. Se entrevistaron 10 diabéticos insulinodependientes con un psicoanalista. Se les propuso el uso de una bomba de insulina. Finalmente 3 la rechazaron. 2 la usaron en forma temporaria y 5 prolongadamente. La colocación de la bomba modifica la relación con el médico. Del saber de todos los diabetólogos, se pasa al mas especializado de los que manejan este objeto técnico. Ocasionalmente, es el médico quien impulsa al paciente a colocarse el aparato sin evaluar adecuadamente si está en condiciones de aceptarlo. Por el contrario, al médico se le suele requerir, como a un distribuidor, este nuevo agente terapéutico. Se distinguieron 3 sentidos; el de bomba dadora (suplanta una función desfallecida), el de objeto a exhibir y el de elemento peligroso (por la dependencia que se establece). Se plantean dos salidas. 1) El rechazao: la bomba demarca con rojo el borde de una herida narcisística; 2) la aceptació, aunque el diabético entra en regresión. Se establecen dos tipos de dependencia; una respecto a la bomba; el diabético no vuelve al control, argumenta que la bomba toma el lugar del saber médico(dependencia-negación; la otra respecto al médico, en cuya ausencia el paciente no va a poder manejar la bomba ni a transmitir claramente a otro médico sus necesidades (dependencia-regresión). Se debe evaluar la actitud, la motivación y la aptitud para operar la bomba

Aspectos psicoanalíticos de diabéticos con bomba de infusión de insulina: previsiones para la selección de pacientes / Psychoanalytical aspects of diabetic patients using insulin pump: the selection of patient

Se intenta determinar las consecuencias psíquicas de la idea de colocación de una bomba de insulina, señalar los sentimientos sobre el aparato según los estilos personales y evaluar el empleo preventivo de las consultas psicológicas. Se entrevistaron 10 diabéticos insulinodependientes con un psicoanalista. Se les propuso el uso de una bomba de insulina. Finalmente 3 la rechazaron. 2 la usaron en forma temporaria y 5 prolongadamente. La colocación de la bomba modifica la relación con el médico. Del saber de todos los diabetólogos, se pasa al mas especializado de los que manejan este objeto técnico. Ocasionalmente, es el médico quien impulsa al paciente a colocarse el aparato sin evaluar adecuadamente si está en condiciones de aceptarlo. Por el contrario, al médico se le suele requerir, como a un distribuidor, este nuevo agente terapéutico. Se distinguieron 3 sentidos; el de bomba dadora (suplanta una función desfallecida), el de objeto a exhibir y el de elemento peligroso (por la dependencia que se establece). Se plantean dos salidas. 1) El rechazao: la bomba demarca con rojo el borde de una herida narcisística; 2) la aceptació, aunque el diabético entra en regresión. Se establecen dos tipos de dependencia; una respecto a la bomba; el diabético no vuelve al control, argumenta que la bomba toma el lugar del saber médico(dependencia-negación; la otra respecto al médico, en cuya ausencia el paciente no va a poder manejar la bomba ni a transmitir claramente a otro médico sus necesidades (dependencia-regresión). Se debe evaluar la actitud, la motivación y la aptitud para operar la bomba(AU)

Alteraciones del metabolismo de los hidratos de carbono y lípidos en la obesidad / Metabolic changes of carbohydrates and lipids in obesity

Se estudaron las alteraciones del metabolismo hidrocarbonado, del metabolismo lipídico y los niveles circulantes de insulina en un grupo de pacientes obesos, comparándolo con sujetos normales no obesos y con diabéticos de peso normal. En cada individuo se determinaron los niveles sanguíneos de: glucosa (G) o prueba de tolerancia oral a la glucosa (PTOG), insulina (I), hemoglobina glicosilada (HbA1), triglicéridos (TG), colesterol total (CT) y colesterol HDL (CHDL). Los resultados obtenidos indican que los obesos presentan alteraciones de diversa magnitud a nivel del metabolismo de la G, que permiten establecer diferentes estadios. Otro tanto ocurre con los niveles circulantes de I. La HbA1 de los obesos con PTOG normal está dentro de los valores normales, pero significativamente elevada con respecto a los controles. De los lípidos analizados, los TG constituyen la fracción más afectada, siguiéndole el CT y el CHDL. Como consecuencia de las alteraciones lipídicas, los obesos presentan un incremento de los índices de riesgo aterogénico CT/CHDL y TG/CHDL

Alteraciones del metabolismo de los hidratos de carbono y lípidos en la obesidad / Metabolic changes of carbohydrates and lipids in obesity

Se estudaron las alteraciones del metabolismo hidrocarbonado, del metabolismo lipídico y los niveles circulantes de insulina en un grupo de pacientes obesos, comparándolo con sujetos normales no obesos y con diabéticos de peso normal. En cada individuo se determinaron los niveles sanguíneos de: glucosa (G) o prueba de tolerancia oral a la glucosa (PTOG), insulina (I), hemoglobina glicosilada (HbA1), triglicéridos (TG), colesterol total (CT) y colesterol HDL (CHDL). Los resultados obtenidos indican que los obesos presentan alteraciones de diversa magnitud a nivel del metabolismo de la G, que permiten establecer diferentes estadios. Otro tanto ocurre con los niveles circulantes de I. La HbA1 de los obesos con PTOG normal está dentro de los valores normales, pero significativamente elevada con respecto a los controles. De los lípidos analizados, los TG constituyen la fracción más afectada, siguiéndole el CT y el CHDL. Como consecuencia de las alteraciones lipídicas, los obesos presentan un incremento de los índices de riesgo aterogénico CT/CHDL y TG/CHDL (AU)

The small intestine in diabetes mellitus. Correlation of clinical phenomena to histomorphometric findings in peroral biopsy material.

Biopsy material obtained from the first portion of the jejunum of 56 unselected diabetics and 21 normal controls was examined under the electron microscope (in 8 cases) or with a method of stereologic morphometry. Controls were found to have a villous volume (VVi) of 50.19 +/- 10.1%. All values below 40% were interpreted as an expression of deterioration of the mucous membrane. Altogether 12.5% of the diabetics showed total atrophy, and 20% had significant reduction of VVi. These changes did not correlate with intestinal disorders or other signs of diabetes. In total atrophy histochemical changes could be demonstrated. Microangiopathy was not observed in the intestinal mucosa.