Hipertensión intracraneal idiopática como forma de presentación de la enfermedad de Addison / Idiopathic intracranial hypotension as the presenting symptom of Addison’s disease

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[Nutritional evaluation in patients with total gastrectomy]. / Evaluación nutricional en pacientes con gastrectomía total.

Gastric cancer continues to be the second cause of cancer-related mortality in the world. Surgery is the only potentially curative therapy, although the adverse effects of surgery are considerable and include digestive symptoms, loss of appetite and malnutrition. Our study included 45 patients subjected to gastrectomy who were under treatment at our unit during 2000. The data given here refer to their first visit following surgery. The most frequent complications were diarrhoea (31%), pain (29%) and early dumping (24%). Other complications found were late dumping, nausea/vomiting and dysphagia. Anorexia appeared in 49% and 29% presented a negative attitude towards food. These complications give rise to insufficient food intake, leading to malnutrition, mainly marasmic in nature. Only 7% of the patients were normonourished, with 86% presenting slight or moderate malnutrition and 7% severe malnutrition. The mean Body Mass Index (BMI) of these patients was 20 +/- 3 kg/m2. The most frequent analytical alterations were anaemia with ferropenia and b12 deficit, and a reduction in the levels of zinc and retinol transporting protein. Many patients had impaired quality of life; 43% did not leave home and only 13% were able to work. Three groups were established depending on the time that had passed since the gastrectomy was performed before the first nutritional assessment (less than 3 months, from three months to a year, and over one year), without significant differences being found in any of the parameters studied. In this article we include recommendations for the nutritional handling and treatment of patients following gastrectomy.

Evaluación nutricional en pacientes con gastrectomía total / Nutritional assessment in patients with total gastrectomy

El cáncer gástrico continúa siendo la segunda causa más frecuente de mortalidad por cáncer en el mundo. La cirugía es el único tratamiento potencialmente curativo, aunque los efectos adversos de la cirugía son importantes e incluyen síntomas digestivos, pérdida de apetito y desnutrición. En nuestro estudio se incluyeron 45 pacientes gastrectomizados que estaban en tratamiento en nuestra unidad en el año 2000. Los datos aquí expuestos se refieren a la primera visita poscirugía. Las complicaciones más frecuentes fueron diarrea (31 por ciento), dolor (29 por ciento) y dumping precoz (24 por ciento). Otras complicaciones fueron dumping tardío, nauseas, vómitos y disfagia. El 49 por ciento presentaban anorexia, el 29 por ciento actitud negativa ante la comida. Estas complicaciones dan lugar a una alimentación insuficiente, generando malnutrición, principamente de tipo marasmática. Sólo el 7 por ciento de los pacientes estaban normonutridos, el 86 por ciento presentaban desnutrición leve o moderada y el 7 por ciento malnutrición severa. El índice de masa corporal (IMC) medio de estos pacientes fue de 20 +/- 3kg/m2. Las alteraciones analíticas más frecuentes fueron anemia con ferropenia y déficit de B12 y disminución de los niveles de zinc y proteína transportadora de retinol. Muchos pacientes veían afectada su calidad de vida; el 43 por ciento no salen de casa y sólo pueden trabajar el 13 por ciento. Se establecieron tres grupos en función del tiempo transcurrido desde la gastrectomía hasta la primera valoración nutricional (menos de 3 meses, entre los tres meses y el año y más de un año) no encontrándose diferencias significativas en ninguno de los parámetros estudiados. En este trabajo incluimos recomendaciones para el manejo y tratamiento nutricional del paciente gastrectomizado (AU)

Gastric cancer continues to be the second cause of cancer-related mortality in the world. Surgery is the only potentially curative therapy, although the adverse effects of surgery are considerable and include digestive symptoms, loss of appetite and malnutrition. Our study included 45 patients subjected to gastrectomy who were under treatment at our unit during 2000. The data given here refer to their first visit following surgery. The most frequent complications were diarrhoea (31%), pain (29%) and early dumping (24%). Other complications found were late dumping, nausea/vomiting and dysphagia. Anorexia appeared in 49% and 29% presented a negative attitude towards food. These complications give rise to insufficient food intake, leading to malnutrition, mainly marasmic in nature. Only 7% of the patients were normonourished, with 86% presenting slight or moderate malnutrition and 7% severe malnutrition. The mean Body Mass Index (BMI) of these patients was 20 ± 3 kg/m2. The most frequent analytical alterations were anaemia with ferropenia and b12 deficit, and a reduction in the levels of zinc and retinol transporting protein. Many patients had impaired quality of life; 43% did not leave home and only 13% were able to work. Three groups were established depending on the time that had passed since the gastrectomy was performed before the first nutritional assessment (less than 3 months, from three months to a year, and over one year), without significant differences being found in any of the parameters studied. In this article we include recommendations for the nutritional handling and treatment of patients following gastrectomy (AU)

[Effect of preconceptional metabolic control in the course of pregnancy in diabetic patients]. / Influencia del control metabólico preconcepcional en la evolución de la gestación de la paciente diabética.

BACKGROUND: We analysed the relationship between metabolic control parameters during the preconception stage and pregnancy outcome in diabetic patients. PATIENTS AND METHOD: We examined 69 diabetic patients who underwent a preconception control at the Diabetes and Pregnancy Unit between 1992-1998. At the end of the preconception care period, 50 women (72.6%) became pregnant. Eight out of them (16%) had an abortion. RESULTS: Women who had an abortion did not differ from those who had not an abortion with regard to HbA1c levels at the end of the preconception period, age, duration of diabetes, age at diagnosis,anti-thyroid antibodies or microvascular disease. Among 41 single age stations, fetal macrosomia was observed in 36.6% cases, neonatal hypoglycemia in 19.5% and major congenital malformations in one case. Average level of HbA1c was 7.6 +/- 1.3%and 6.5 +/- 0.7 at the beginning and at the end of the preconception period, respectively (p < 0.001). In the group with macrosomia,average HbA1c at the end of the preconception period was 6.8 +/- 0.66% as opposed to 6.3 +/- 0.7% for the non-macrosomic group (p < 0.05). A linear correlation was seen between HbA1c levels at the end of the preconception period and infant weight (r = 0,432; p = 0,014), birth weight ratio (r = 0,450; p = 0,009), and a morbidity score (r = 0,458;p = 0,007). CONCLUSIONS: A better metabolic control during the preconception period may contribute to lessen the risk of fetal macrosomia and neonatal morbidity.