Carcinoma papilar tiroideo asociado al carcinoma de células escamosas / Papillary thyroid carcinoma associated to squamous cell carcinoma

No disponible

Coordinación multidisciplinaria en el abordaje de la diabetes mellitus tipo 2 / Multidisciplinary coordination in the approach to type 2 diabetes mellitus

La diabetes tipo 2 (DM2) constituye el paradigma de la enfermedad crónica. Se trata de un proceso que afecta a varios órganos y sistemas, se acompaña de otros procesos y disminuye la calidad de vida de los pacientes. Los pacientes diabéticos presentan complicaciones microvasculares y un incremento de riesgo en la morbimortalidad cardiovascular, relacionadas, entre otras, con la calidad asistencial de la atención que se les presta. La calidad de la gestión del proceso asistencial va íntimamente relacionada con el grado de control que se hace del proceso, la calidad de la atención recibida, la calidad de vida y, en definitiva, con el grado de responsabilización que hace el diabético de su propia enfermedad. En España se han desarrollado algunos proyectos de coordinación entre la atención especializada y la atención primaria –cuidados compartidos– para mejorar la atención al paciente con DM2. Entre otros, el proyecto UDEN-Territorial de Girona (UDENTG), que está dando lugar a resultados muy alentadores. La UDENTG es una intervención dirigida a una mejora en la organización asistencial del paciente endocrinológico, en especial con DM2. A pesar de su complejidad, se está demostrando que es efectiva y equitativa con las demandas de esta enfermedad y permite un mejor desarrollo profesional para todos los implicados (AU)

Type 2 diabetes mellitus (DM2) is the paradigm of chronic disease. DM2 is a process that affects various organs and systems, is accompanied by other diseases and reduces patients’ quality of life. Patients with diabetes show microvascular complications and an increased risk of cardiovascular morbidity and mortality related to the quality of the healthcare received, among other factors. The quality of the management of the healthcare process is intimately connected to the degree of diabetes control, the quality of the care received, quality of life and the degree to which the diabetic patient feels empowered to manage his or her disease. In Spain, several projects to coordinate specialized and primary care —shared care— have been developed to improve the management of patients with DM2. Among others, the UDEN project, in Gerona (UDENTG), is providing highly promising results. UDENTG is an intervention aimed at improving the organization of the care of endocrinological patients, especially those with DM2. Despite its complexity, this project is demonstrating its effectiveness and equitableness in DM2 and is improving professional development in all those involved (AU)

[Multidisciplinary coordination in the approach to type 2 diabetes mellitus]. / Coordinación multidisciplinaria en el abordaje de la diabetes mellitus tipo 2.

Type 2 diabetes mellitus (DM2) is the paradigm of chronic disease. DM2 is a process that affects various organs and systems, is accompanied by other diseases and reduces patients' quality of life. Patients with diabetes show microvascular complications and an increased risk of cardiovascular morbidity and mortality related to the quality of the healthcare received, among other factors. The quality of the management of the healthcare process is intimately connected to the degree of diabetes control, the quality of the care received, quality of life and the degree to which the diabetic patient feels empowered to manage his or her disease. In Spain, several projects to coordinate specialized and primary care -shared care- have been developed to improve the management of patients with DM2. Among others, the UDEN project, in Gerona (UDENTG), is providing highly promising results. UDENTG is an intervention aimed at improving the organization of the care of endocrinological patients, especially those with DM2. Despite its complexity, this project is demonstrating its effectiveness and equitableness in DM2 and is improving professional development in all those involved.

Tratamiento con radioyodo en el hipertiroidismo: resultados a largo plazo / Radioiodine in hyperthyroidism: long-term outcomes

Introducción: El 131I es una opción terapéutica eficaz para el tratamiento del hipertiroidismo, aunque en un alto porcentaje de pacientes se desarrolla hipotiroidismo definitivo. Objetivo: Evaluar la función tiroidea a largo plazo de pacientes con hipertiroidismo tras el tratamiento con 131I. Pacientes y método: Se estudió retrospectivamente a 128 pacientes hipertiroideos que recibieron 131I entre 1994 y 1999. Se excluyó a 32 por pérdida en el seguimiento y se clasificó a los 96 sujetos incluidos, según la afección tiroidea, en GB (Graves-Basedow, n = 46), BMN (bocio multinodular, n = 35) y AT (adenoma tóxico, n = 15). El tiempo de seguimiento fue 7,3 ± 0,2 años y la dosis media de 131I, 12,2 ± 0,3 mCi. Resultados: De los 96 pacientes, en el 58,3% se desarrolló hipotiroidismo, el 34,4% mantenía normofunción tiroidea y el 7,3% restante permanecía con hiperfunción clínica o subclínica. El 19,8% (n = 19) precisó más de una dosis de 131I. En el grupo GB, el 87% evolucionó a hipotiroidismo, el 10,9% persistía eutiroideo y el 2,1%, con hiperfunción; recibieron 2 dosis de 131I 10 (21,7%) pacientes. Del grupo BMN, el 28,6% quedó hipotiroideo; el 54,3%, eutiroideo y el 17,1%, con hiperfunción; 7 (20%) pacientes necesitaron 2 dosis y 2 (5,7%) pacientes, 3 dosis. En el grupo AT, el 40% desarrolló hipotiroidismo y el 60% mantenía normofunción tiroidea; 2 (13,3%) pacientes recibieron 2 dosis. Conclusiones: La tasa de hipotiroidismo definitivo en el grupo GB es superior a la de los otros 2 grupos. El alto porcentaje de pacientes con BMN que persisten hipertiroideos tras 131I indica que son necesarias dosis superiores en este grupo

Background: Radioiodine treatment is a safe and effective therapeutic option for hyperthyroidism, although the incidence of subsequent definitive hypothyroidism is high. Objective: To evaluate long-term thyroid function after radioiodine treatment in hyperthyroid patients. Patients and method: We performed a retrospective study of 128 hyperthyroid patients administered 131I between 1994 and 1999. We excluded 32 patients who were lost to follow-up. The 96 patients included were categorized into Graves' disease (GD), n = 46, toxic multinodular goiter (TMG), n = 35, and toxic adenoma (TA), n = 15. The mean time of follow-up was 7.3 ± 0.2 years and the mean 131I dose was 12.2 ± 0.3 mCi. Results: Among the 96 patients, hypothyroidism developed in 58.3%, normal thyroid function was achieved in 34.4% and some degree of hyperthyroidism persisted in 7.3%. More than one radioiodine dose was required in 19.8% (n = 19). In GD patients, hypothyroidism appeared in 87%, euthyroidism was achieved in 10.9%, and hyperthyroidism persisted in 2.1%. Ten patients required second 131I doses. In the TMG group, hypothyroidism developed in 28.6%, euthyroidism was achieved in 54.3% and hyperthyroidism was present in 17.1%. Seven patients (20%) were administered a second radioiodine dose and two patients (5.7%) received a third dose. In the TA group, hypothyroidism developed in 40% and euthyroidism was achieved in 60%. Two patients (13.3%) received a second 131I dose. Conclusions: The incidence of definitive hypothyroidism was higher in the GD group than in the TMG and TA groups. The high percentage of TMG patients with persistent hyperthyroidism suggests the need for higher radioiodine doses in this group