Diabetes mellitus and cardiovascular risk: an update of the recommendations of the Diabetes and Cardiovascular Disease Working Group of the Spanish Society of Diabetes (SED, 2021). / Diabetes mellitus y riesgo cardiovascular: actualización de las recomendaciones del Grupo de Trabajo de Diabetes y Enfermedad Cardiovascular de la Sociedad Española de Diabetes (SED, 2021).

This document is an update to the clinical practice recommendations for the management of cardiovascular risk factors (CVRF) in diabetes mellitus. The consensus has been developed by a multidisciplinary team made up of members of the Cardiovascular Risk Group of the Spanish Diabetes Society (SED). The work is a necessary update as, since the last review three years ago, there have been many clinical trials that have studied the cardiovascular outcomes of numerous drugs in the diabetic population. We believe that this guideline update may be of interest to all clinicians treating patients with diabetes.

Diabetes mellitus y riesgo cardiovascular. Actualización de las recomendaciones del Grupo de Trabajo de Diabetes y Riesgo Cardiovascular de la Sociedad Española de Diabetes (SED, 2018) / Diabetes mellitus and cardiovascular risk: Update of the recommendations of the Diabetes and Cardiovascular Disease working group of the Spanish Diabetes Society (SED, 2018)

El presente documento es una actualización de las recomendaciones de práctica clínica para el manejo de los factores de riesgo cardiovascular en la diabetes mellitus. Este consenso está elaborado por los miembros del Grupo de Riesgo Cardiovascular de la Sociedad Española de Diabetes (SED). Se han propuesto y actualizado las intervenciones sobre el estilo de vida, tratamiento farmacológico indicado para alcanzar los objetivos terapéuticos según los niveles de HbA1c, grado de obesidad, hipertensión arterial, hiperlipemia, insuficiencia cardiaca, antiagregación plaquetaria, insuficiencia renal y diabetes en el anciano, así como nuevos biomarcadores de interés en la evaluación del riesgo cardiovascular. El trabajo es una actualización de las intervenciones y objetivos terapéuticos; además, se señala la necesidad de la inclusión de los especialistas en Endocrinología, Metabolismo y Nutrición en las Unidades de Rehabilitación Cardiaca para el control y seguimiento de esta población

This document is an update to the clinical practice recommendations for the management of cardiovascular risk factors in diabetes mellitus. The consensus is made by members of the Cardiovascular Risk Group of the Spanish Diabetes Society. We have proposed and updated interventions on lifestyle, pharmacological treatment indicated to achieve therapeutic objectives according to the levels of HbA1c, degree of obesity, hypertension, hyperlipidemia, heart failure, platelet antiagregation, renal insufficiency, and diabetes in the elderly, as well as new biomarkers of interest in the evaluation of cardiovascular risk in individuals with diabetes mellitus. The work is an update of the interventions and therapeutic objectives in addition, it is noted the need for the inclusion of specialists in Endocrinology, Metabolism and Nutrition in Cardiac Rehabilitation Units for the control and monitoring of this population

Diabetes mellitus and cardiovascular risk: Update of the recommendations of the Diabetes and Cardiovascular Disease working group of the Spanish Diabetes Society (SED, 2018). / Diabetes mellitus y riesgo cardiovascular. Actualización de las recomendaciones del Grupo de Trabajo de Diabetes y Riesgo Cardiovascular de la Sociedad Española de Diabetes (SED, 2018).

This document is an update to the clinical practice recommendations for the management of cardiovascular risk factors in diabetes mellitus. The consensus is made by members of the Cardiovascular Risk Group of the Spanish Diabetes Society. We have proposed and updated interventions on lifestyle, pharmacological treatment indicated to achieve therapeutic objectives according to the levels of HbA1c, degree of obesity, hypertension, hyperlipidemia, heart failure, platelet antiagregation, renal insufficiency, and diabetes in the elderly, as well as new biomarkers of interest in the evaluation of cardiovascular risk in individuals with diabetes mellitus. The work is an update of the interventions and therapeutic objectives in addition, it is noted the need for the inclusion of specialists in Endocrinology, Metabolism and Nutrition in Cardiac Rehabilitation Units for the control and monitoring of this population.

Traducción y validación de un cuestionario para la detección de trastornos del comportamiento alimentario en pacientes con diabetes mellitus / Translation and validation of the Diabetes Eating Problem Survey to screen eating disorders in patients with type-1 diabetes mellitus

Introducción: El tratamiento de la diabetes mellitus tipo 1 (DMT1) exige modificaciones de los hábitos alimentarios y estilos de vida que pueden conducir a desarrollar trastornos de la conducta alimentaria (TCA). Es necesaria la detección precoz de estos trastornos en sujetos con DMT1. Sin embargo, no existe un cuestionario específico sobre la presencia de TCA en este tipo de pacientes. Objetivos: Traducir y validar al español un cuestionario específico para detectar el riesgo de TCA en sujetos con DMT1. Analizar su concordancia con una versión resumida y con la herramienta de referencia EAT-26. Material y métodos: Estudio transversal. La muestra estuvo compuesta por 112 adultos con DMT1. Para la detección del riesgo de TCA se utilizaron los cuestionarios EAT-26 y DEPS-R. Características como el peso, la talla, el IMC, la edad y la edad de inicio fueron evaluadas. Resultados: Se evaluaron las propiedades estructurales de la prueba a través de procedimientos metodológicos para calcular la fiabilidad y la validez. La versión traducida y adaptada demostró una consistencia muy elevada entre la versión completa y la resumida (α = 0,821). La prueba test-retest también resultó consistente (coeficiente de correlación intraclase de 95,8% para EPAD y de 92,3% para EPAD-R). El análisis factorial resultó dar 5 factores: 1) Actitudes alimentarias; 2) Conductas bulímicas; 3) Control de peso; 4) Evitación, y 5) Restricción. Conclusiones: Hemos desarrollado un cuestionario en español capaz de identificar el riesgo de TCA específico para sujetos con DMT1. El cuestionario EPAD-R detectó un 10% más de casos y estos fueron diferentes a los detectados por el EAT-26. Para identificar correctamente los TCA en diabéticos es necesario utilizar herramientas de cribado específicas (AU)

Introduction: The treatment of type-1 diabetes mellitus (T1DM) requires changes in patients’ eating habits and lifestyles which could lead to the development of an eating disorder (ED). An early detection of these disorders in subjects with T1DM is necessary. However, there is no specific questionnaire concerning the presence of an ED in these patients. Objectives: To translate and validate for the Spanish population a specific questionnaire aimed at detecting the risk of onset of an ED on a sample of subjects with T1DM. To analyze its agreement with its shortened version and with the gold standard tool, EAT-26. Material and methods: Cross-sectional study. The study population consisted of 112 adults with T1DM. The EAT-26 tool and DEPS-R questionnaire were used to detect subjects at risk for developing ED. In addition, several characteristics such as weight, height, BMI, age and age of onset were assessed by means of self-administered questionnaires, in order to study their correlation with test scoring. Results: Structural properties of the tests were evaluated through methodological procedures aimed at calculating reliability and validity. The translated and adapted version had a high consistency in both its complete and summarized version (α = 0,821).The test-retest also yielded consistent results (intraclass correlation coefficient 95.8% for EPAD and 92.3% for EPAD-R). The factor analysis yielded 5 factors: 1) Eating attitudes; 2) Bulimic behavior; 3) Weight control; 4) Avoidance, and 5) Restriction. Conclusions: We have developed a questionnaire in Spanish capable of identifying the risk of onset of a specific ED in patients with T1DM. The EPAD-R questionnaire detected 10% more cases and different ones than those detected by the EAT-26 test. It is necessary to use specific screening tools to correctly identify eating disorders in patients with T1DM (AU)

Translation and validation of the Diabetes Eating Problem Survey to screen eating disorders in patients with type-1 diabetes mellitus. / Traducción y validación de un cuestionario para la detección de trastornos del comportamiento alimentario en pacientes con diabetes mellitus.

INTRODUCTION: The treatment of type-1 diabetes mellitus (T1DM) requires changes in patients' eating habits and lifestyles which could lead to the development of an eating disorder (ED). An early detection of these disorders in subjects with T1DM is necessary. However, there is no specific questionnaire concerning the presence of an ED in these patients. OBJECTIVES: To translate and validate for the Spanish population a specific questionnaire aimed at detecting the risk of onset of an ED on a sample of subjects with T1DM. To analyze its agreement with its shortened version and with the gold standard tool, EAT-26. MATERIAL AND METHODS: Cross-sectional study. The study population consisted of 112 adults with T1DM. The EAT-26 tool and DEPS-R questionnaire were used to detect subjects at risk for developing ED. In addition, several characteristics such as weight, height, BMI, age and age of onset were assessed by means of self-administered questionnaires, in order to study their correlation with test scoring. RESULTS: Structural properties of the tests were evaluated through methodological procedures aimed at calculating reliability and validity. The translated and adapted version had a high consistency in both its complete and summarized version (α=0,821).The test-retest also yielded consistent results (intraclass correlation coefficient 95.8% for EPAD and 92.3% for EPAD-R). The factor analysis yielded 5 factors: 1) Eating attitudes; 2) Bulimic behavior; 3) Weight control; 4) Avoidance, and 5) Restriction. CONCLUSIONS: We have developed a questionnaire in Spanish capable of identifying the risk of onset of a specific ED in patients with T1DM. The EPAD-R questionnaire detected 10% more cases and different ones than those detected by the EAT-26 test. It is necessary to use specific screening tools to correctly identify eating disorders in patients with T1DM.

Diabetes mellitus y riesgo cardiovascular: recomendaciones del Grupo de Trabajo Diabetes y Enfermedad Cardiovascular de la Sociedad Española de Diabetes (SED, 2015) / Diabetes mellitus and cardiovascular risk: Working group recommendations of Diabetes and Cardiovascular Disease of the Spanish Society of Diabetes (SED, 2015)

El presente documento actualiza las recomendaciones de práctica clínica del manejo de los factores de riesgo cardiovascular (FRCV) en la diabetes mellitus (DM). Es un consenso médico realizado por un panel de expertos independiente de la Sociedad Española de Diabetes (SED). Se han propuesto y actualizado varios consensos de diferentes sociedades científicas o médicas con el fin de mejorar los resultados terapéuticos. La valoración del RCV en la población general puede carecer de sensibilidad para la evaluación individual en determinados grupos de riesgo como los diabéticos. Se revisan los factores de riesgo tradicionales y no tradicionales, así como las estrategias de intervención para el control de los FRCV en los pacientes diabéticos como la dieta, el control ponderal, el ejercicio físico, los hábitos tóxicos, el control glucémico, tensional y lipídico, así como la antiagregación plaquetaria. Confiamos en que estas pautas ayuden a los médicos en la toma de decisiones en su actividad asistencial. Se expone una actualización de los conceptos más relevantes y de mayor interés clínico-práctico y, a su vez realista, para reducir el RCV de los diabéticos como se venía haciendo regularmente por parte del Grupo de Enfermedad Cardiovascular de la SED

The present paper updates the Clinical Practice Recommendations for the management of cardiovascular risk factors (CVRF) in diabetes mellitus. This is a medical consensus agreed by an independent panel of experts from the Spanish Society of Diabetes (SED). Several consensuses have been proposed by scientific and medical Societies to achieve clinical goals. However, the risk score for general population may lack sensitivity for individual assessment or for particular groups at risk, such as diabetics. Traditional risk factors together with non-traditional factors are reviewed throughout this paper. Intervention strategies for managing CVRF in the diabetic patient are reviewed in detail: balanced food intake, weight reduction, physical exercise, smoking cessation, reduction in HbA1c, therapy for high blood pressure, obesity, lipid disorders, and platelet anti-aggregation. It is hoped that these guidelines can help clinicians in the decisions of their clinical activity. This regular update by the SED Cardiovascular Disease Group of the most relevant concepts, and of greater practical and realistic clinical interest, is presented in order to reduce CVR of diabetics

[Diabetes mellitus and cardiovascular risk: Working group recommendations of Diabetes and Cardiovascular Disease of the Spanish Society of Diabetes (SED, 2015)]. / Diabetes mellitus y riesgo cardiovascular: recomendaciones del Grupo de Trabajo Diabetes y Enfermedad Cardiovascular de la Sociedad Española de Diabetes (SED, 2015).

The present paper updates the Clinical Practice Recommendations for the management of cardiovascular risk factors (CVRF) in diabetes mellitus. This is a medical consensus agreed by an independent panel of experts from the Spanish Society of Diabetes (SED). Several consensuses have been proposed by scientific and medical Societies to achieve clinical goals. However, the risk score for general population may lack sensitivity for individual assessment or for particular groups at risk, such as diabetics. Traditional risk factors together with non-traditional factors are reviewed throughout this paper. Intervention strategies for managing CVRF in the diabetic patient are reviewed in detail: balanced food intake, weight reduction, physical exercise, smoking cessation, reduction in HbA1c, therapy for high blood pressure, obesity, lipid disorders, and platelet anti-aggregation. It is hoped that these guidelines can help clinicians in the decisions of their clinical activity. This regular update by the SED Cardiovascular Disease Group of the most relevant concepts, and of greater practical and realistic clinical interest, is presented in order to reduce CVR of diabetics.

Diabetes mellitus y riesgo cardiovascular: recomendaciones del Grupo de Trabajo Diabetes y Enfermedad Cardiovascular de la Sociedad Española de Diabetes (SED, 2015) / Diabetes mellitus and cardiovascular risk: Working group recommendations of Diabetes and Cardiovascular Disease of the Spanish Society of Diabetes (SED, 2015)

El presente documento actualiza las recomendaciones de práctica clínica del manejo de los factores de riesgo cardiovascular (FRCV) en la diabetes mellitus (DM). Es un consenso médico realizado por un panel de expertos independiente de la Sociedad Española de Diabetes (SED). Se han propuesto y actualizado varios consensos de diferentes sociedades científicas o médicas con el fin de mejorar los resultados terapéuticos. La valoración del RCV en la población general puede carecer de sensibilidad para la evaluación individual en determinados grupos de riesgo como los diabéticos. Se revisan los factores de riesgo tradicionales y no tradicionales, así como las estrategias de intervención para el control de los FRCV en los pacientes diabéticos como la dieta, el control ponderal, el ejercicio físico, los hábitos tóxicos, el control glucémico, tensional y lipídico, así como la antiagregación plaquetaria. Confiamos en que estas pautas ayuden a los médicos en la toma de decisiones en su actividad asistencial. Se expone una actualización de los conceptos más relevantes y de mayor interés clínico-práctico y, a su vez realista, para reducir el RCV de los diabéticos como se venía haciendo regularmente por parte del Grupo de Enfermedad Cardiovascular de la SED

The present paper updates the Clinical Practice Recommendations for the management of cardiovascular risk factors (CVRF) in diabetes mellitus. This is a medical consensus agreed by an independent panel of experts from the Spanish Society of Diabetes (SED). Several consensuses have been proposed by scientific and medical Societies to achieve clinical goals. However, the risk score for general population may lack sensitivity for individual assessment or for particular groups at risk, such as diabetics. Traditional risk factors together with non-traditional factors are reviewed throughout this paper. Intervention strategies for managing CVRF in the diabetic patient are reviewed in detail: balanced food intake, weight reduction, physical exercise, smoking cessation, reduction in HbA1c, therapy for high blood pressure, obesity, lipid disorders, and platelet anti-aggregation. It is hoped that these guidelines can help clinicians in the decisions of their clinical activity. This regular update by the SED Cardiovascular Disease Group of the most relevant concepts, and of greater practical and realistic clinical interest, is presented in order to reduce CVR of diabetics

[Diabetes mellitus and cardiovascular risk: Working group recommendations of Diabetes and Cardiovascular Disease of the Spanish Society of Diabetes (SED, 2015)]. / Diabetes mellitus y riesgo cardiovascular: recomendaciones del Grupo de Trabajo Diabetes y Enfermedad Cardiovascular de la Sociedad Española de Diabetes (SED, 2015).

The present paper updates the Clinical Practice Recommendations for the management of cardiovascular risk factors (CVRF) in diabetes mellitus. This is a medical consensus agreed by an independent panel of experts from the Spanish Society of Diabetes (SED). Several consensuses have been proposed by scientific and medical Societies to achieve clinical goals. However, the risk score for general population may lack sensitivity for individual assessment or for particular groups at risk, such as diabetics. Traditional risk factors together with non-traditional factors are reviewed throughout this paper. Intervention strategies for managing CVRF in the diabetic patient are reviewed in detail: balanced food intake, weight reduction, physical exercise, smoking cessation, reduction in HbA1c, therapy for high blood pressure, obesity, lipid disorders, and platelet anti-aggregation. It is hoped that these guidelines can help clinicians in the decisions of their clinical activity. This regular update by the SED Cardiovascular Disease Group of the most relevant concepts, and of greater practical and realistic clinical interest, is presented in order to reduce CVR of diabetics.

Factores psicosociales en la diabetes mellitus tipo 1 y su relación con el riesgo de desarrollar trastornos alimentarios en la infancia y la adolescencia / Psychosocial factors in type 1 diabetes mellitus and their relationship with the risk of developing eating disorders in children and adolescents

INTRODUCCIÓN: El tratamiento de la diabetes tipo 1 (DMT1) exige modificaciones de los hábitos alimentarios y estilos de vida que puede conducir a desarrollar trastornos de la conducta alimentaria (TCA). Por lo tanto, se hace necesaria la detección precoz de estos trastornos. Existe escasa evidencia sobre la presencia de TCA y/o su relación con características psicosociales en este tipo de pacientes. OBJETIVOS: Estimar el número de sujetos en riesgo de TCA sobre una muestra de jóvenes con DMT1 con 2 herramientas distintas y analizar su concordancia, estableciendo la relación entre los niveles de ansiedad, depresión, calidad de vida y funcionamiento emocional sobre el riesgo de desarrollar TCA. MATERIAL Y MÉTODOS: Estudio transversal. La población estudiada estuvo compuesta por 40 jóvenes con DMT1 y 40 sujetos control. Para la detección de sujetos en riesgo de TCA se utilizó la herramienta EAT-26/ChEAT y el cuestionario DEPS/R. Diversas características, como depresión, ansiedad y relación con compañeros y familiares, se evaluaron mediante test autoadministrados. RESULTADOS: Existe gran disparidad al identificar riesgo de TCA en sujetos con DMT1. Así, el cuestionario DEPS-R detectó un 40% más de casos que el EAT-26. Las conductas obsesivas, la fobia social y las relaciones con los semejantes se asociaron significativamente con el riesgo de TCA (p < 0,05 en todos los casos). CONCLUSIONES: Para identificar correctamente los TCA en pacientes con DMT1 es necesario el desarrollo de herramientas de cribado específicas. Además, se debería educar a estos pacientes a manejar de forma eficaz situaciones sociales que puedan producir ansiedad y conductas indeseadas

INTRODUCTION: Type 1 diabetes (T1DM) treatment involves lifestyle changes that can lead to classic eating disorders (ED) like anorexia or bulimia. However, there is a lack of evidence on the presence of ED and/or its relation with psychosocial characteristics of these subjects. OBJECTIVE: To estimate the number of subjects at risk of ED in a T1DM youth population sample using two different tools and to analyze its concordance, establishing the relations between anxiety, depression, quality of life and emotional-management, and the risk of developing ED. MATERIAL AND METHODS: The population studied consisted of 40 young subjects with T1DM and40 control peers. To detect ED, EAT-26/ChEAT test for the general population and DEPS/R specific for T1DM was performed. Several characteristics such as depression, anxiety and peer relationships were analyzed by self-administered validated tests. RESULTS: There is a great disparity in identifying ED in the T1DM patients on using the screening tool used. Thus, DEPS-R showed 40% more subjects at risk than the EAT-26 test. Obsessive behavior, social phobia, and peer-relationships and family-relationships were significantly associated with the risk of developing ED (P < 0.05 in all cases).CONCLUSIONS: To properly identify ED in T1DM patients, it would be necessary to develop specific screening tools that take into account the lifestyle modifications undergone by these patients. In addition, to prevent the development of ED, these patients should be taught to efficiently manage social situations that could lead to anxiety and undesirable behaviors

Differential effect of oral dehydroepiandrosterone-sulphate on metabolic syndrome features in pre- and postmenopausal obese women.

OBJECTIVE: To analyze the effect in obese pre- and postmenopausal women of a daily dose of 100 mg dehydroepiandrosterone-sulphate (DHEA-S) provided over a period of 3 months as replacement therapy against metabolic syndrome. CONTEXT: Although DHEA-S appears to be effective against certain features of metabolic syndrome, its usefulness against this syndrome as a whole has not been evaluated to date. DESIGN/PATIENTS: A randomized, double-blind placebo-controlled trial was conducted involving 61 postmenopausal women, who received DHEA-S (n = 41) or placebo (n = 20) for 3 months. The effect of DHEA-S treatment on the same postmenopausal women was compared with the effects observed in a group of premenopausal women (n = 20). MEASUREMENTS: Anthropometric measurements were taken at the beginning and at the end of the treatment. Similarly, different parameters that define metabolic syndrome and other cardiometabolic variables were determined. RESULTS: Dehydroepiandrosterone-sulphate replacement produced weight loss in the obese women studied. Moreover, waist circumference, glucose and systolic and diastolic blood pressure, among other metabolic syndrome parameters, improved in the postmenopausal group, who showed a significant reduction in the total metabolic syndrome score (P < 0·05). In contrast, in premenopausal women, the effect of DHEA-S was limited to obesity parameters, and no effect was observed on metabolic syndrome components. No significant changes were evident in the placebo group. CONCLUSIONS: An oral dose of DHEA-S is useful for weight loss. In obese postmenopausal women, the hormone significantly improves plasma biochemical levels and anthropometric characteristics, leading to a better metabolic profile, which highlights the usefulness of this therapy against metabolic syndrome in this group of women.

Relation between degree of obesity and site-specific adipose tissue fatty acid composition in a Mediterranean population.

OBJECTIVE: Obesity itself could be a key factor determining fatty acid (FA) composition of adipose tissue (AT). A Mediterranean diet influences this relationship. However, a relation between different overweight and obesity levels (including morbidly obese subjects) and AT FA pattern has not been fully established. The objective of the present study was to analyze potential differences in AT FA composition attending to degree of obesity in patients who follow a Mediterranean dietary pattern. METHODS: Our study comprises 60 patients classified as overweight, obese, or morbidly obese (20 subjects in each group). Dietary composition was assessed by a 7-d record, and visceral and subcutaneous AT FAs were analyzed by gas chromatography. Cardiometabolic risk-related parameters were also assessed. RESULTS: Our results showed that dietary habits were similar among groups, although palmitic intake was higher and palmitoleic intake was lower in the morbidly obese group. Concerning AT, we observed significant differences in the visceral depot. Concretely, both total monounsaturated FA (P = 0.039) and palmitoleic acid (P = 0.008) were higher in overweight subjects. Most differences were found in the subcutaneous tissue. Among them, n-9 and total monounsaturated FA (P < 0.001) were significantly higher again in overweight subjects, while 22:6n-3 was higher in morbidly obese subjects. Subcutaneous adipose dihommo-γ-linolenic content and dietary palmitic and palmitoleic acids were independent predictors of body mass index. CONCLUSIONS: We confirm the relationship between degree of obesity and dietary and AT FA composition in this Mediterranean population. Despite a similar dietary pattern among groups, overweight and morbidly obese patients have a less detrimental FA profile than obese patients, probably due to differences in adipose tissue metabolism.

[Toxic intrathoracic goiter. Clinical profile and surgical morbidity in an endocrine surgery unit]. / Bocio intratorácico tóxico. Perfil clínico y morbilidad quirúrgica en una unidad de cirugía endocrina.

BACKGROUND: The development of postsurgical complications is exacerbated when several risk factors coincide in the same patient. OBJECTIVE: To analyze the results of surgery for toxic intrathoracic goiter in terms of (a) the need for sternotomy; (b) morbidity and mortality; and (c) remission of compressive symptoms. MATERIAL AND METHODS: A review (1980-2002) was carried out of 43 cases of toxic intrathoracic multinodular goiter according to Eschapase's definition (3 cm below the sternal manubrium) occurring in patients without previous thyroid surgery who underwent total thyroidectomy. There were 2 control groups: I (non-toxic intrathoracic goiter, without recurrence and not requiring total thyroidectomy) and II (non-intrathoracic, non-toxic goiter without recurrence, requiring total thyroidectomy). The following variables were analyzed: sociopersonal, clinical and surgical characteristics, morbidity, mortality, and outcome. RESULTS: Compared with the control groups, the patient group had longer disease duration and was older. In 6 patients (14%) 1 was difficulty in intubation, and 2 patients required fiberoptic intubation. All goiters could be extirpated through the cervical route. The morbidity rate was 37% (n=16). Notably, 4 were recurrent lesions (9%), 1 of which was definitive, and 14 were hyperparathyroidism (33%), one of which was definitive. The only difference between the control groups and the patient group was a greater incidence of transitory hypoparathyroidism in the patient group than in control group II (33% versus 15%; p=0.0103). Surgical outcomes were excellent in terms of symptom remission. CONCLUSIONS: In any unit with ample experience of endocrine surgery, total thyroidectomy in toxic intrathoracic goiter can be carried out with a low risk of postsurgical complications, a low incidence of sternotomies and complete symptom remission. In intrathoracic goiter surgery, the presence of associated hyperthyroidism does not increase postoperative morbidity.

Bocio intratorácico tóxico. Perfil clínico y morbilidad quirúrgica en una unidad de cirugía endocrina / Toxic intrathoracic goiter. Clinical profile and surgical morbidity in an endocrine surgery unit

Introducción El desarrollo de complicaciones posquirúrgicas se acentúa cuando en un mismo paciente coinciden varios factores de riesgo. Objetivo: analizar en el bocio intratorácico tóxico los resultados quirúrgicos en cuanto a: 1) necesidad de esternotomía; 2) morbimortalidad postoperatoria, y 3) remisión de la sintomatología compresiva. Material y métodos Revisión retrospectiva (1980–2002) de 43 bocios multinodulares intratorácicos según la definición de Eschapase (3cm debajo del manubrio esternal), tóxicos, sin cirugía tiroidea previa y sometidos a una tiroidectomía total. Grupos controles: i (bocio intratorácico no tóxico ni recidivado sometido a una tiroidectomía total) y ii (bocio no intratorácico ni tóxico ni recidivado sometido a una tiroidectomía total). Se analizan variables sociopersonales, clínicas, quirúrgicas, morbimortalidad y de evolución. Resultados Comparando con los grupos control, los pacientes a estudio presentan mayor tiempo de evolución y mayor edad. En 6 casos (14%) se presentó dificultad en la intubación, precisando 2 de ellos fibrobroncoscopio para la intubación. Todos los bocios pudieron ser extirpados por vía cervical. La morbilidad fue del 37% (n=16), entre las que destacan 4 lesiones recurrenciales (9%), una de ellas definitiva, y 14 hipoparatiroidismos (33%), uno de ellos definitivo. Comparando con los grupos control, se evidencia que la única diferencia es la existencia de una mayor incidencia de hipoparatiroidismos transitorios respecto al grupo control ii (el 33 frente al 15%; p=0,0103). Los resultados en cuanto a la remisión de la (..) (AU)

Background The development of postsurgical complications is exacerbated when several risk factors coincide in the same patient. Objective: To analyze the results of surgery for toxic intrathoracic goiter in terms of (a) the need for sternotomy; (b) morbidity and mortality; and (c) remission of compressive symptoms. Material and methods A review (1980–2002) was carried out of 43 cases of toxic intrathoracic multinodular goiter according to Eschapase's definition (3cm below the sternal manubrium) occurring in patients without previous thyroid surgery who underwent total thyroidectomy. There were 2 control groups: I (non-toxic intrathoracic goiter, without recurrence and not requiring total thyroidectomy) and II (non-intrathoracic, non-toxic goiter without recurrence, requiring total thyroidectomy). The following variables were analyzed: sociopersonal, clinical and surgical characteristics, morbidity, mortality, and outcome. Results Compared with the control groups, the patient group had longer disease duration and was older. In 6 patients (14%) 1 was difficulty in intubation, and 2 patients required fiberoptic intubation. All goiters could be extirpated through the cervical route. The morbidity rate was 37% (n=16). Notably, 4 were recurrent lesions (9%), 1 of which was definitive, and 14 were hyperparathyroidism (33%), one of which was definitive. The only difference between the control groups and the patient group was a greater incidence of transitory hypoparathyroidism in the patient group than in control group II (33% versus 15%; p=0.0103). Surgical outcomes (..) (AU)

Surgical management of multinodular goiter with compression symptoms.

HYPOTHESIS: Multinodular goiter (MG) with compression symptoms has a clinical profile different from that of goiter without these symptoms. The surgical treatment of MG with compression symptoms has a high rate of sternotomy and morbidity. DESIGN: Retrospective study conducted between 1970 and 1999. SETTING: Tertiary referral center. PATIENTS: One hundred fifty-seven patients with MG with compression symptoms were reviewed from 672 patients with MG undergoing surgery in our department. We used 515 patients with MG without compression symptoms as a control group. INTERVENTION: All 157 patients underwent programmed surgery for thyroidectomy. MAIN OUTCOME MEASURES: General patient data, history and symptoms, exploration (both physical and with complementary techniques), data on the surgery and surgeon, and postsurgery morbidity and evolution. The chi2 test, the t test, and a logistic regression test were applied. RESULTS: Multinodular goiter with compression symptoms is characterized by its appearance in persons older than 55 years, a preoperative evolution of more than 10 years, and an intrathoracic component in more than 75% (P<.001). All the patients underwent surgery, with 6 (4%) requiring a sternotomy. Twenty-four percent had complications (n = 37), 3% of which corresponded to 4 cases of permanent recurrent laryngeal nerve injury. Eleven patients (7%) had an associated thyroid carcinoma, 9 of them corresponding to microcarcinomas. However, 5 were multifocal, and there was 1 anaplastic carcinoma, from which the patient died. All the papillary carcinomas are currently asymptomatic. The symptoms were remitted after surgery in all the cases except 1 dysphonia. Of the 32 patients receiving partial surgery, 9 (28%) had recurrence, of whom 6 underwent reoperation to complete the thyroidectomy. CONCLUSIONS: Multinodular goiter with compression symptoms occurs in long-evolving goiters with an intrathoracic component. Surgery is the definitive treatment, as it excludes malignancy, involves low rates of permanent morbidity and mortality, and, if the technique is total thyroidectomy, avoids recurrences.

Utility of fine-needle aspiration for diagnosis of carcinoma associated with multinodular goitre.

BACKGROUND: Fine-needle aspiration (FNA) is a useful method for evaluating a solitary thyroid nodule; however, this is not an agreed method for a multinodular goitre (MNG). The aim of this study was to assess the utility of preoperative FNA for detecting malignancy in MNG. PATIENTS AND METHOD: We analysed operated MNGs in which FNA had been performed. Puncture was carried out on the dominant nodule and any other nodules with features suggesting malignancy. The diagnosis was classed as colloid, follicular or Hurthle proliferation, suggestive of malignancy, haematic and inadequate. The thyroid FNA results, grouped into suggestive of malignancy (positive result) and other diagnoses (negative result), were compared to those of the final histological study in order to calculate the value of the test in diagnosing malignancy. RESULTS: FNA was performed in 432 MNGs, of which 42 (9.7%) were associated with carcinoma. Overall, the results of the test were poor, revealing a sensitivity of 17%, specificity of 96% and diagnostic accuracy of 88%, with a positive predictive value of 32% and negative predictive value of 88%. When the values were recalculated with the exclusion of microcarcinomas--considering their minor clinical importance--there was a slight improvement in the results: the sensitivity increased to 26%, diagnostic accuracy to 93% and negative predictive value to 96%. However, the specificity remained at 96%, and the positive predictive value fell from 32% to 25%. The results of the test improved in multifocal carcinomas. CONCLUSIONS: Thyroid fine needle aspiration is not useful for differentiating MNG with malignant degeneration from benign MNG, as more than 80% of carcinomas go unnoticed; it provides a sensitivity of 17% for detecting carcinomas, rising to 26% if microcarcinomas are excluded. We therefore suggest that clinical criteria should prevail over FNA.

Diagnóstico perioperatorio de malignidad asociada al bocio multinodular / Perioperative diagnosis of malignancy in multinodular goiter

Introducción. La incidencia de malignidad en el bocio multinodular (BM) oscila entre el 1 y el 10 por ciento; su diagnóstico es difícil, excepto si se dispone de una histología definitiva. Los objetivos de este trabajo son: a) determinar los factores clínicos de riesgo de malignidad del BM, y b) valorar la utilidad de la ecografía, la citología (PAAF) y la biopsia intraoperatoria (BIO) en el BM para detectar malignidad. Pacientes y método. Se revisan 672 BM intervenidos, de los cuales 59 (8,8 por ciento) presentan un carcinoma tiroideo asociado. Se analizan diferentes variables, como los factores pronósticos, y los resultados de la ecografía, la PAAF y la BIO para descartar malignidad. El diagnóstico de estas exploraciones fue clasificado como positivo (indicativo de malignidad) y negativo (resto de diagnósticos) y se comparó con el de la histología definitiva con el fin de calcular el valor de dichas técnicas para el diagnóstico de malignidad. Resultados. Las variables independientes asociadas a la presencia de carcinoma sobre un bocio son los antecedentes familiares de enfermedad tiroidea (riesgo relativo [RR] = 1,6), el antecedente de radioterapia cervical (RR = 1,8), el bocio recidivado (RR = 2,1) y las adenopatías cervicales (RR = 1,6). La ecografía presentó una sensibilidad del 14 por ciento para descartar malignidad, con un valor predictivo positivo del 29 por ciento y una seguridad diagnóstica del 89 por ciento. La PAAF presentó una sensibilidad del 17 por ciento, una especificidad del 96 por ciento y una seguridad diagnóstica del 88 por ciento, con un valor predictivo positivo del 32 por ciento y negativo del 88 por ciento. Por último, la BIO mostró una sensibilidad del 19 por ciento, una especificidad del 100 por ciento, un valor predictivo positivo del 100 por ciento, un valor predictivo negativo del 93 por ciento y una seguridad diagnóstica del 93 por ciento. Conclusiones. La ecografía, la PAAF y la BIO tienen una baja sensibilidad para el diagnóstico de BM por lo que, ante la sospecha de malignidad, deben tenerse en cuenta los criterios clínicos en la toma de decisiones (AU)

[Comparative study of the type of obesity in pre- and postmenopausal women: Relationship with fat cell data, fatty acid composition and endocrine, metabolic, nutritional and psychological variables]. / Estudio comparativo del tipo de obesidad en mujeres pre y posmenopáusicas: relación con el tamaño adipocitario, la composición de la grasa y diferentes variables endocrinas, metabólicas, nutricionales y psicológicas.

BACKGROUND: The weight increase that many women experience during menopause may be the result of ageing. However, the precise factors inducing obesity during this period remain to be identified. The object of this study was to determine the type of obesity in a group of women along with its distinctive features, if any, as a function of the menopause stage. PATIENTS AND METHOD: The sample consisted of 55 women (22 premenopausal and 33 postmenopausal) with grade I and II obesity. Distribution of body fat, composition of the adipose tissue, size and number of adipocytes, lipidic and hormonal profile as well as nutritional and psychological aspects were all taken into account. RESULTS: Postmenopausal women had an android distribution of fat, whereas it was gynoid in premenopausal women. The adipose tissue showed different cell characteristics, the number of fat cells and content of saturated fatty acids (myristic and palmitic) being significantly lower in the postmenopausal group. Menopause was associated with an increase in plasmatic lipids and a decrease in the levels of certain hormones (dehydroepiandrosterone-sulphate and insulin). Postmenopausal women tended to have healthier eating habits than premenopausal women, with a significantly lower fat intake but higher carbohydrate and fibre intakes. However, the degree of physical activity was lower than in premenopausal women. CONCLUSIONS: The type of obesity differs as a function of the menopausal status, a finding that should be taken into account when establishing a dietetic treatment.

Estudio comparativo del tipo de obesidad en mujeres pre y posmenopáusicas: relación con el tamaño adipocitario, la composición de la grasa y diferentes variables endocrinas, metabólicas, nutricionales y psicológicas / Comparative study of the type of obesity in pre- and postmenopausal women: Relationship with fat cell data, fatty acid composition and endocrine, metabolic, nutritional and psychological variables

FUNDAMENTO: El incremento de peso que aparece durante la menopausia podría ser consecuencia del envejecimiento; aun así, todavía no se han definido qué factores concretos actúan como inductores de obesidad durante este período de transición. El objetivo del estudio ha sido determinar el tipo de obesidad en un grupo de mujeres y sus diferencias en función del estado menopáusico. PACIENTES Y MÉTODOS: La muestra se componía de 55 mujeres (22 premenopáusicas y 33 posmenopáusicas) con obesidad grados I y II. Se han tenido en cuenta la distribución de grasa corporal, la composición del tejido adiposo, el tamaño y número de adipocitos, el perfil lipídico y hormonal, así como los aspectos nutricionales y psicológicos. RESULTADOS: La mujer posmenopáusica presentó una distribución de grasa corporal androide, a diferencia de la premenopáusica, que fue ginoide. Su tejido adiposo presentó características celulares diferentes, siendo el número de adipocitos y el contenido en ácidos grasos saturados (mirístico y palmítico) significativamente menor. Durante la menopausia se produjo, a su vez, un incremento de los lípidos plasmáticos y una disminución de diferentes hormonas (sulfatodeshidroepiandrosterona e insulina). La mujer posmenopáusica presentó unos hábitos alimentarios más saludables que la premenopáusica, con un porcentaje de grasas significativamente inferior y una proporción de glúcidos y fibra superior. Aun así el grado de actividad física fue inferior al de las mujeres premenopáusicas. CONCLUSIONES: El tipo de obesidad en la mujer difiere en función de la existencia de menopausia. Este hecho debería tenerse en cuenta a la hora de establecer un tratamiento dietético (AU)