Microvascular complications and risk factors in patients with type 2 diabetes

Realizar un estudio prospectivo en sujetos con diabetes mellitus tipo 2 (DM2) sin complicaciones microvasculares, analizando la asociación entre varios factores de riesgo al inicio y el desarrollo de complicaciones microvasculares durante el seguimiento. Métodos Estudio prospectivo, observacional en 376 sujetos con DM2 incluidos en 2004. El objetivo clínico final fue la excreción urinaria de albúmina (EUA) > 30mg/24h y/o presencia de retinopatía al final del seguimiento en 2007. Basalmente las variables fueron: edad, sexo, duración de la diabetes, glucosa plasmática en ayunas, hemoglobina glucada (HbA1c), presión arterial sistólica y diastólica, peso, talla, índice de masa corporal, circunferencia de la cintura, colesterol total, triglicéridos, colesterol unido a lipoproteína de alta densidad (c-HDL), colesterol unido a lipoproteína de baja densidad (c-LDL), proteína C reactiva de alta sensibilidad (PCR-as), fibrinógeno, EUA, creatinina, tabaquismo, ejercicio, consumo de alcohol, utilización de medicación hipoglucemiante, hipolipemiante e hipotensora, y otros datos relacionados con los antecedentes familiares de diabetes y factores de riesgo. Resultados Al final del seguimiento 95 sujetos (25,2%) desarrollaron una complicación microvascular. En el análisis de regresión logística, los principales factores de riesgo independientes fueron la EUA > 12mg/24h (odds ratio [OR]: 6,12; p=0,000), la PCR-as > 3mg/l (OR: 3,00; p=0,004) y la hipertensión (OR: 2,43; p=0,023). Conclusiones Los niveles de EUA superiores a 12mg/24h, la PCR-as > 3mg/l y la presencia de hipertensión fueron factores de riesgo independientes para el desarrollo de complicaciones microvasculares en los sujetos con DM2 estudiados (AU)

To conduct a prospective study in patients with type 2 diabetes mellitus (T2DM) with no microvascular complications, analyzing the association between various baseline risk factors and development of microvascular complications at follow-up.MethodsA prospective, observational study in 376 patients with T2DM enrolled in 2004. The clinical end-point was urinary albumin excretion (UAE) > 30mg/24h and/or presence of retinopathy at follow-up in 2007. Baseline variables included age, gender, duration of T2DM, fasting plasma glucose, glycated hemoglobin (HbA1c), systolic and diastolic blood pressure, body weight, height, body mass index, waist circumference, total cholesterol, triglycerides, high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), high sensitive C-reactive protein (hs-CRP), fibrinogen, UAE, creatinine, smoking status, exercise, alcohol consumption, use of hypoglycemic and lipid-lowering drugs, antihypertensive medications, and other data related to family history of diabetes and risk factors.Results Ninety-five subjects (25.2%) developed a microvascular complication at the end of the follow-up period. In logistic regression analyses, the main independent risk factors were UAE >12mg/24h (odds ratio [OR]: 6.12; P=.000), hs-CRP> 3mg/L (OR: 3.00; P=.004), and hypertension (OR: 2.43; P=.023).ConclusionsUAE levels higher than 12mg/24h, hs-CRP >3mg/L, and presence of hypertension were all independent risk factors for development of microvascular complications in patients with T2DM studied (AU)

Microvascular complications and risk factors in patients with type 2 diabetes.

AIM: To conduct a prospective study in patients with type 2 diabetes mellitus (T2DM) with no microvascular complications, analyzing the association between various baseline risk factors and development of microvascular complications at follow-up. METHODS: A prospective, observational study in 376 patients with T2DM enrolled in 2004. The clinical end-point was urinary albumin excretion (UAE) > 30mg/24h and/or presence of retinopathy at follow-up in 2007. Baseline variables included age, gender, duration of T2DM, fasting plasma glucose, glycated hemoglobin (HbA(1c)), systolic and diastolic blood pressure, body weight, height, body mass index, waist circumference, total cholesterol, triglycerides, high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), high sensitive C-reactive protein (hs-CRP), fibrinogen, UAE, creatinine, smoking status, exercise, alcohol consumption, use of hypoglycemic and lipid-lowering drugs, antihypertensive medications, and other data related to family history of diabetes and risk factors. RESULTS: Ninety-five subjects (25.2%) developed a microvascular complication at the end of the follow-up period. In logistic regression analyses, the main independent risk factors were UAE >12mg/24h (odds ratio [OR]: 6.12; P=.000), hs-CRP> 3mg/L (OR: 3.00; P=.004), and hypertension (OR: 2.43; P=.023). CONCLUSIONS: UAE levels higher than 12mg/24h, hs-CRP >3mg/L, and presence of hypertension were all independent risk factors for development of microvascular complications in patients with T2DM studied.

Long-term outcome in 215 children and adolescents with papillary thyroid cancer treated during 1940 through 2008.

BACKGROUND: Controversy exists regarding the aggressiveness of initial therapy in childhood papillary thyroid cancer (PTC). Few studies with long-term outcome exist and second primary malignancies have rarely been analyzed. METHODS: We studied 215 PTC patients younger than 21 years old managed during 1940 through 2008. The patients were aged 3-20 year old (median age = 16 years); the median follow-up was 29 years. Recurrence and mortality details were taken from a computerized database. RESULTS: Median primary tumor size was 2.2 cm. Six percent had distant metastases at presentation, 5% had incomplete tumor resection, 86% had nodes removed at initial surgery, and 78% had nodal metastases. After complete surgical resection, PTC recurred in 32% by 40 years. At 20 years, the recurrence rates at local, regional, and distant sites were 7, 21, and 5%, respectively. During 1940-1969, local and regional recurrence rates after unilateral lobectomy (UL) were significantly (P < 0.001) higher than after bilateral lobar resection (BLR). During 1950-2008 radioiodine remnant ablation (RRA) was administered within 18 months to 32%; it did not diminish the 25-year regional recurrence rate of 16% seen after BLR alone (P = 0.86). Only two fatal events from PTC occurred at 28 and 30 years, for a cause-specific mortality at 40 years of only 2%. All-causes mortality rates did not exceed expectation through 20 years, but from 30 through 50 years, the number of deaths was significantly (P < 0.001) higher than predicted. Fifteen of 22 deaths (68%) resulted from nonthyroid malignancy. CONCLUSION: Survival from childhood PTC should be expected, but later death from nonthyroid malignancy is disconcerting. Seventy-three percent of those who died from nonthyroid malignancy had received postoperative therapeutic irradiation.

Papillary thyroid microcarcinoma: a study of 900 cases observed in a 60-year period.

BACKGROUND: The study aims were to characterize patients with papillary thyroid microcarcinoma (PTM) and to describe post-surgical outcome. METHODS: Nine hundred PTM patients had initial treatment at Mayo Clinic during 1945-2004. Mean follow-up was 17.2 years. Recurrence and mortality details were derived from a computerized database. RESULTS: Median tumor size was 7 mm; 98% were intrathyroidal. 273 patients (30%) had neck nodal involvement; 3 (0.3%) had distant metastases at diagnosis. Seven-hundred and sixty-five (85%) underwent bilateral lobar resection (BLR; total-, near-total, or bilateral subtotal thyroidectomy). Regional nodes were removed by either "node picking" (27%) or compartmental dissection (23%). Tumor resection was incomplete in 5 (0.6%). Radioiodine remnant ablation (RRA) was performed in 155 (17%). Overall survival did not differ from expected for an age and gender matched control group (P = .96); 3 patients (0.3%) died of PTM. None of the 892 patients with initial complete tumor resection developed metastatic spread during 20 postoperative years. Twenty-year and 40-year tumor recurrence rates were 6% and 8%, respectively. Higher recurrence rates were seen with multifocal tumors (P = .004) and node-positive patients (P < .001). Neither more extensive surgery nor RRA reduced recurrence rates compared to unilateral lobectomy. CONCLUSION: More than 99% of PTM patients are not at risk of distant spread or cancer mortality. RRA after BLR did not improve postoperative outcome.

Captación de 123I-MIBG (metayodobencilguanidina) en un adenoma hepático / 123I-MIBG scintigraphy uptake in a hepatic lesion

El feocromocitoma es un tumor derivado de las células cromafines de la médula adrenal. Cuando afecta a células situadas en la cadena simpática, se denomina paraganglioma. Pese a ser infrecuente, debe incluirse entre las posibles causas de hipertensión, arritmias cardíacas y crisis de ansiedad. Presentamos el caso de una mujer con un feocromocitoma vesical y una lesión hepatocelular con captación positiva en el estudio isotópico con MIBG (metayodobencilguanidina) que se ha interpretado como un falso positivo El mielolipoma adrenal es un tumor benigno, poco frecuente, compuesto por tejido adiposo maduro y elementos hematopoyéticos diversos. Su hallazgo suele ser incidental, aunque en ocasiones pueden alcanzar gran tamaño y causar dolor abdominal y otros síntomas clínicos. La ecografía y la tomografía computarizada son herramientas útiles en su diagnóstico. Los tumores pequeños (< 6 cm) y asintomáticos pueden tratarse de forma conservadora con vigilancia periódica y los > 6 cm o con síntomas pueden precisar tratamiento quirúrgico. Presentamos un caso de mielolipoma adrenal gigante y a continuación se realiza una revisión de la literatura (AU)

Pheochromocytoma is a tumor derived from the chromaffin cells of the adrenal medulla. When this type of tumor involves the sympathetic ganglia it is called paraganglioma. Although infrequent, paraganglioma should be considered in the evaluation of hypertension, arrhythmias, and panic disorder. We report the case of a woman with bladder pheochromocytoma and a hepatic lesion. MIBG scintigraphy showed non-physiological uptake, which was interpreted as a false positive result (AU)

(123)I-mibg scintigraphy uptake in a hepatic lesion.

Pheochromocytoma is a tumor derived from the chromaffin cells of the adrenal medulla. When this type of tumor involves the sympathetic ganglia it is called paraganglioma. Although infrequent, paraganglioma should be considered in the evaluation of hypertension, arrhythmias, and panic disorder. We report the case of a woman with bladder pheochromocytoma and a hepatic lesion. MIBG scintigraphy showed non-physiological uptake, which was interpreted as a false positive result.

Acidosis láctica, en relación con insuficiencia renal aguda y metformina, tratada con hemodiálisis con bicarbonato / A case of lactic acidosis related to acute renal failure and metformin intake treated with bicarbonate haemodialysis

La acidosis láctica es una rara enfermedad con una mortalidad en torno al 50%. Se caracteriza por una acidosis metabólica con anión gap y ácido láctico elevado. Presentamos un caso de acidosis láctica en una paciente diabética en tratamiento con metformina, que presentó una insuficiencia renal aguda secundario a deshidratación por un cuadro de gastroenteritis. El tratamiento con hemodiálisis venovenosa continua fue exitoso con recuperación gradual de la función renal. Se describe el caso clínico, los mecanismos fisiopatológicos, las diferentes causas y el pronóstico de esta infrecuente y grave complicación (AU)

Lactic acidosis is a rare entity. Mortality is approximately 50%. Lactic acidosis is characterized by metabolic acidosis with elevated blood lactate and anion gap. We present a case of lactic acidosis in a diabetic woman under treatment with metformin. The patient developed acute renal failure due to dehydration and diarrhea. Treatment with continuous venovenoushemodialysis was successful with clinical improvement and recovery of renal function. We describe the case and review the pathophysiological causes and prognosis of this infrequent and severe complication (AU)