Patient satisfaction in three advanced hybrid closed-loop systems at 6 months of treatment in adults with type 1 diabetes mellitus: a follow-up study.

INTRODUCTION: Advanced hybrid closed-loop (AHCL) systems have demonstrated improved glycemic control in individuals with Type 1 Diabetes Mellitus. The aim of this study is to compare patient satisfaction among three available AHCL systems (Medtronic Minimed780 G, Roche Diabeloop DBLG1, and Tandem t:slim X2 Control IQ) after six months of treatment and to determine if it is related to glycemic control. METHODS: The data of 75 individuals were analyzed, including 15 using the DBLG1 system, 9 using Control IQ, and 51 using MM780 G. Patient satisfaction was assessed using the Diabetes Treatment Satisfaction Questionnaire for Diabetes Mellitus (DTSQc), a validated instrument. RESULTS: All systems demonstrated treatment satisfaction. The DBLG-1 system scored 14 (-15-21) points, while Control IQ scored 21 (9-24) and M780 G scored 19 (11-24) (p = 0.004). The multivariate analysis revealed that the DBLG-1 system is associated with a lower DTSQc score (OR 0.19, p = 0.019) independent of glycemic control, sex, age, duration of diabetes, duration as an insulin pump user, and daily insulin dose. CONCLUSION: AHCL systems are satisfactory treatments for users, with potential variations observed between each system regardless of the achieved glycemic control.

Rendimiento del sistema Bethesda en el diagnóstico citopatológico del nódulo tiroideo / Efficiency of the Bethesda System for Thyroid Cytopathology

INTRODUCCIÓN: La punción-aspiración con aguja fina es una pieza clave en la evaluación preoperatoria del nódulo tiroideo y el sistema Bethesda es el más aceptado para categorizar el análisis citológico. El objetivo del estudio es evaluar la validez del sistema Bethesda en la enfermedad nodular tiroidea para diagnosticar malignidad. MÉTODOS: Se incluye a los pacientes intervenidos de tiroides consecutivamente entre junio de 2010 y junio de 2017. Se realizó el análisis de la punción preoperatoria según el sistema Bethesda, correlacionando este dato con la histología definitiva para cada nódulo biopsiado. Los parámetros de prueba diagnóstica se calcularon como prueba de screening (verdadero positivo: categorías IV, V, VI) y como método para identificar malignidad (verdadero positivo: categorías V, VI). RESULTADOS: Se incluyó a 522 pacientes, de los que 184 (35,2%) presentaron un carcinoma en la histología definitiva; siendo el carcinoma papilar el más frecuente (84,2%). Los porcentajes de malignidad en el nódulo biopsiado para cada categoría Bethesda fueron: I, 0%; II, 1,5%; III, 6,4%; IV, 31%; V, 86,5% y VI, 100%. En el análisis como prueba de screening, se identificó una sensibilidad del 98,9%, especificidad del 84,4%, valor predictivo positivo del 69,6%, valor predictivo negativo del 99,5% y precisión diagnóstica global del 88,2%. En el análisis para detectar malignidad, los parámetros fueron: sensibilidad 98,6%, especificidad 97,6%, valor predictivo positivo 93,5%, valor predictivo negativo 99,5% y precisión diagnóstica global 97,9%. CONCLUSIONES: El sistema Bethesda es un método sencillo y reproducible en la categorización citológica del nódulo tiroideo, una herramienta útil en el manejo y eficaz para identificar el riesgo de malignidad

INTRODUCTION: To establish quality standards in oncologic surgery is a complex but necessary challenge to improve surgical outcomes. Unlike other tumors, there are no well-defined quality standards in pancreatic cancer. The aim of this study is to identify quality indicators in pancreatic oncologic surgery in Spain as well as their acceptable limits of variability. METHODS: Quality indicators were selected based on clinical practice guidelines, consensus conferences, reviews and national publications on oncologic pancreatic surgery between the years 2000 and 2016. Variability margins for each indicator have been determined by statistical process control techniques and graphically represented with the 99.8 and 95% confidence intervals above and below the weighted average according to sample size. RESULTS: The following indicators have been determined with their weighted average and acceptable quality limits: resectability rate 71% (> 58%), morbidity 58% (< 73%), mortality 4% (< 10%), biliary leak 6% (< 14%), pancreatic fistula rate 18% (< 29%), hemorrhage 11% (< 21%), reoperation rate 11% (< 20%) and mean hospital stay (< 21 days). CONCLUSIONS: To date, few related series have been published, and they present important methodological limitations. Among the selected indicators, the morbidity and mortality quality limits have come out higher than those obtained in international standards. It is necessary for Spanish pancreatic surgeons to adopt homogeneous criteria regarding indicators and their definitions to allow for the comparison of their results

Efficiency of the Bethesda System for Thyroid Cytopathology. / Rendimiento del sistema Bethesda en el diagnóstico citopatológico del nódulo tiroideo.

INTRODUCTION: Fine-needle aspiration biopsies are a key tool for preoperative assessment of thyroid nodules, and the Bethesda system is the preferred method to report cytological analysis. The purpose of this study is to assess the efficiency of the Bethesda system to identify the malignancy risk of thyroid nodules. METHODS: Patients who underwent thyroid surgery between June 2010 and June 2017 were included. Samples were classified into 6categories according to rates of malignancy associated with each diagnostic category. In order to investigate the correlation between categories, a statistical analysis compared the categories with pathology reports. Diagnostic indicators were calculated as a screening test (categories IV, V, VI as true-positive) and as a method to identify malignancy (V, VI as true-positive). RESULTS: In a series of 522 patients, we found 184 (35.2%) malignant tumours, papillary carcinoma being the most prevalent with 155 cases (84.2%). Malignant rates for diagnostic categories were: I, 0%; II, 1.5%; III, 6.4%; IV, 31%; V, 86.5%; VI, 100%. A robust correlation was identified between categories on statistical analysis. For the «screening test¼ analysis, sensitivity was 98.9%, specificity 84.4%, positive predictive value 69.6%, negative predictive value 99.5%, and diagnostic accuracy 88.2%. Analysing the accuracy to detect malignancy, values were: sensitivity 98.6%, specificity 97.6%, positive predictive value 93.5%, negative predictive value 99.5%, diagnostic accuracy 97.9%. CONCLUSION: The Bethesda system is a clear and reliable approach to report thyroid cytology and therefore is an effective tool to identify malignancy risk and guide clinical management.

[Treatment of clinically nonfunctioning pituitary adenomas]. / Tratamiento de los adenomas hipofisarios clínicamente no funcionantes.

Clinically nonfunctioning adenomas are the most frequent pituitary macroadenomas in adults. These tumors are characterized by the absence of detectable hormonal hypersecretion and are diagnosed when compression symptoms or hormonal deficiencies occur. The treatment of choice of macroadenomas is surgery, but tumoral resection is often incomplete or the patient develops tumoral recurrence. Medical therapy has been shown to produce modest tumoral reduction in some patients. Postoperative irradiation should be considered in patients with large tumoral remnants or enlargement of remnants during follow-up. Stereotactic radiotherapy has been developed to diminish the long-term complications of radiotherapy. Microadenomas tend to remain small and surveillance alone is recommended. The present article reviews the results of medical, surgical and radiation treatments.

Tratamiento de los adenomas hipofisarios clínicamente no funcionantes / Treatment of clinically nonfunctioning pituitary adenomas

Los adenomas hipofisarios clínicamente no funcionantes son los macroadenomas más frecuentes en adultos. Se caracterizan por no acompañarse de hipersecreción hormonal detectable en plasma y diagnosticarse cuando aparece sintomatología compresiva o déficits hormonales. El tratamiento de elección es la resección quirúrgica, pero es frecuente que no sea curativa o haya recidivas y se requieran tratamientos adicionales. Los fármacos tienen escasa eficacia y solo han conseguido pequeñas reducciones tumorales en algunos pacientes. Debe considerarse tratamiento con RT postquirúrgica en pacientes con grandes restos o crecimiento de los restos durante el seguimiento. Las técnicas estereotáxicas se han desarrollado para disminuir las complicaciones de la irradiación. En los microadenomas el crecimiento no es frecuente, por lo que solo se recomienda observación (AU)

Clinically nonfunctioning adenomas are the most frequent pituitary macroadenomas in adults. These tumors are characterized by the absence of detectable hormonal hypersecretion and are diagnosed when compression symptoms or hormonal deficiencies occur. The treatment of choice of macroadenomas is surgery, but tumoral resection is often incomplete or the patient develops tumoral recurrence. Medical therapy has been shown to produce modest tumoral reduction in some patients. Postoperative irradiation should be considered in patients with large tumoral remnants or enlargement of remnants during follow-up. Stereotactic radiotherapy has been developed to diminish the long-term complications of radiotherapy. Microadenomas tend to remain small and surveillance alone is recommended. The present article reviews the results of medical, surgical and radiation treatments (AU)

Cabergolina en la hiperprolactinemia y enfermedad vascular cardíaca / Cabergoline in hyperprolactinemia and valvular heart disease

Introducción: La cabergolina a dosis elevadas se ha relacionado con insuficiencia valvular y retracción y engrosamiento valvular en pacientes con enfermedad de Parkinson. Objetivos: Realizar un análisis sistemático de las publicaciones sobre pacientes con hiperprolactinemia tratados con cabergolina y su efecto en las válvulas cardíacas. Resultados: Ninguna de las 7 series revisadas, con 463 pacientes en total, detectó insuficiencia valvular clínicamente significativa. Se encontró insuficiencia tricuspídea (IT) moderada sólo en un estudio, e IT ligera en otras 2 publicaciones. El aumento del área de tenting mitral sólo se ha demostrado en uno de los dos estudios realizados. Hubo calcificaciones y engrosamiento valvular solamente en una de las series. Conclusiones: La cabergolina parece ser segura a las dosis empleadas en la hiperprolactinemia. Hay aumento de prevalencia de IT como hallazgo ecográfico, pero es asintomática. Aunque se precisan estudios longitudinales prospectivos, se recomienda la vigilancia de los pacientes tratados, especialmente con dosis elevadas (AU)

Introduction: High-dose cabergoline therapy has been related to cardiac valve regurgitation in patients with Parkinson’s disease. Aims: To perform a systematic analysis of reports on low-dose cabergoline treatment in hyperprolactinemia and its effect on the cardiac valves. Results: None of the seven reports analyzed, including 463 patients in total, found clinically significant valve regurgitation. Only one report found moderate tricuspid valve regurgitation, and other two reports found mild tricuspid valve regurgitation. An increase in the mitral tenting area was documented in only one of two reports. Valve thickening and calcifications were found in only one study. Conclusions: Cabergoline seems to be safe at the doses employed in hyperprolactinemic patients. There is a higher prevalence of tricuspid regurgitation, detected by systematic echocardiography, but this abnormality is asymptomatic. Although prospective longitudinal studies are needed, vigilance of these patients is recommended, especially those treated with high-dose cabergoline (AU)

[Prevalence, etiology and clinical findings of Cushing's syndrome]. / Prevalencia, etiología y cuadro clínico del síndrome de Cushing.

Endogenous Cushing's syndrome is a very rare entity, with an incidence of 2-4 cases per million inhabitants per year. Cases caused by ectopic ACTH secretion are under-diagnosed. Cushing's disease is the most frequent cause of endogenous Cushing's syndrome, which is 5 or 6 times more frequent than adrenal Cushing's syndrome, with an incidence of between 1.2 and 2.4 cases per million inhabitants per year. Cushing's disease is 3-8 times higher in women than in men. The frequency of adrenal tumors is 3 times higher in women, while that of Cushing's syndrome due to adrenal tumors is 3-5 times higher. Age at diagnosis of Cushing's syndrome varies according to the etiology. Most cases of Cushing's disease are due to a pituitary adenoma, although the tumor may not be visible on the available imaging techniques. ACTH-independent Cushing's syndrome is found in 20% of cases and is most frequently due to adenomas (10%) or adrenal carcinomas (8). Bilateral micronodular hyperplasia and macronodular hyperplasia are infrequent entities, representing less than 10% of all cases of ACTH-independent Cushing's syndrome. Both familial and sporadic forms exist: the familial form, or Carney complex, and ACTH-independent bilateral macronodular hyperplasia, in which the size of the adrenal glands is considerably enlarged. The signs and symptoms of Cushing's syndrome are a direct result of long-term exposure to excessive glucocorticoids. Most signs and symptoms are highly prevalent in the general population (hypertension, central obesity, diabetes mellitus or carbohydrate intolerance, osteoporosis, and characteristic phenotypical alterations).

Prevalencia, etiología y cuadro clínico del síndrome de Cushing / Prevalence, etiology and clinical findings of Cushing¿s syndrome

El síndrome de Cushing endógeno es una entidad muy rara; su incidencia es de 2 a 4 casos por millón de habitantes y año. Hay que tener en cuenta la subestimación de los causados por secreción ectópica de corticotropina. La enfermedad de Cushing es la causa más frecuente del síndrome, unas 5 o 6 veces más frecuente que el síndrome de Cushing de origen suprarrenal. Tiene una incidencia entre 1,2 y 2,4 casos por millón de habitantes y año. La mujer tiene una frecuencia de 3 a 8 veces mayor que el varón para desarrollarla, 3 veces mayor para padecer afección tumoral suprarrenal, y de 3 a 5 veces mayor para padecer un síndrome de Cushing por tumor suprarrenal. La edad de diagnóstico del síndrome de Cushing varía con la etiología. La gran mayoría de las enfermedades de Cushing se deben a un adenoma hipofisario, aunque a menudo éste no sea visible mediante técnicas de imagen disponibles. El síndrome de Cushing no dependiente de corticotropina ocurre en aproximadamente el 20% de los casos. La mayoría se debe a adenomas (10%) o carcinomas (8%) suprarrenales. La hiperplasia micronodular bilateral y la hiperplasia macronodular son entidades raras, menos de 10% del total de casos del síndrome no dependiente de corticotropina. Existen formas familiares y esporádicas. La forma familiar, o complejo de Carney, y la hiperplasia macronodular bilateral no dependiente de corticotropina, en la que hay un aumento considerable del tamaño de las glándulas suprarrenales. Los signos y síntomas del síndrome de Cushing resultan directamente de la exposición crónica a un exceso de glucocorticoides. La mayoría de los síntomas y signos son muy prevalentes en la población general (hipertensión arterial, obesidad central, diabetes mellitus o intolerancia a los hidratos de carbono, osteoporosis y cambios fenotípicos característicos) (AU)

Endogenous Cushing's syndrome is a very rare entity, with an incidence of 2-4 cases per million inhabitants per year. Cases caused by ectopic ACTH secretion are under-diagnosed. Cushing’s disease is the most frequent cause of endogenous Cushing’s syndrome, which is 5 or 6 times more frequent than adrenal Cushing’s syndrome, with an incidence of between 1.2 and 2.4 cases per million inhabitants per year. Cushing’s disease is 3-8 times higher in women than in men. The frequency of adrenal tumors is 3 times higher in women, while that of Cushing’s syndrome due to adrenal tumors is 3-5 times higher. Age at diagnosis of Cushing’s syndrome varies according to the etiology. Most cases of Cushing’s disease are due to a pituitary adenoma, although the tumor may not be visible on the available imaging techniques. ACTH-independent Cushing’s syndrome is found in 20% of cases and is most frequently due to adenomas (10%) or adrenal carcinomas (8). Bilateral micronodular hyperplasia and macronodular hyperplasia are infrequent entities, representing less than 10% of all cases of ACTH-independent Cushing’s syndrome. Both familial and sporadic forms exist: the familial form, or Carney complex, and ACTH-independent bilateral macronodular hyperplasia, in which the size of the adrenal glands is considerably enlarged. The signs and symptoms of Cushing’s syndrome are a direct result of long-term exposure to excessive glucocorticoids. Most signs and symptoms are highly prevalent in the general population (hypertension, central obesity, diabetes mellitus or carbohydrate intolerance, osteoporosis, and characteristic phenotypical alterations) (AU)

Déficit de yodo en una población de mujeres embarazadas pertenecientes a un área con leve deficiencia de yodo / Iodine deficiency in pregnant women from a mildly iodine-deficient area

Objetivo: Los estudios realizados en España proponen que la ingesta de yodo de las mujeres embarazadas está por debajo de los requerimientos nutricionales. Con este estudio se pretende conocer el estado nutricional de yodo en una población de mujeres embarazadas de Madrid. Pacientes y método: Estudio prospectivo de una cohorte de 112 mujeres gestantes con enfermedad endocrina entre enero y septiembre de 2004. Resultados: La yoduria fue 101,5 (60,25-176,75) µg/l. Sólo el 30,4% de las mujeres mostraban suficiencia de yodo (yoduria > 160 µg/l). La tirotropina fue 2,1 (1,12-2,95) µU/ml; la tiroxina libre, 0,87 (0,77-1) ng/dl; los anticuerpos antitiroglobulina y los anticuerpos antiperoxidasa, positivos en el 5,4 y el 19,6% respectivamente. En el análisis bivariable, el consumo de sal yodada se asoció con la suficiencia de yodo (odds ratio [OR] = 3,6; intervalo de confianza [IC] del 95%, 1,45-8,93). El 41,3% de las consumidoras de sal yodada presentaron yodurias > 160 µg/l, frente al 16,3% de las no consumidoras (p = 0,004). No hubo asociación entre suficiencia de yodo y antecedentes familiares de enfermedad tiroidea, bocio, tratamiento con levotiroxina, tirotropina, tiroxina libre, anticuerpos antitiroglobulina ni anticuerpos antiperoxidasa. En el análisis multivariable, la OR ajustada del consumo de sal yodada sobre la suficiencia nutricional de yodo fue 3,92 (1,46-10,53; p = 0,008). Conclusiones: En esta muestra, el 69,6% de las gestantes presentaron yodurias < 160 µg/l. El consumo de sal yodada se asoció a suficiencia de yodo. En esta cohorte no encontramos asociación de suficiencia de yodo con positividad de anticuerpos antitiroglobulina y anticuerpos antiperoxidasa ni con concentraciones de tirotropina y tiroxina libre

Objective: Studies performed in Spain suggest that iodine intake in pregnant women is below nutritional requirements. This study was designed to determine the degree of iodine nutrition during pregnancy in women from Madrid. Patients and method: A prospective study of 112 pregnant women with endocrinological disorders was performed between January 2004 and September 2004. Results: The urinary iodine level was 101.5 µg/l (60.25-176.75). Only 30.4% of the women showed adequate urinary iodine levels (higher than 160 µg/l). Serum thyroid-stimulating hormone (TSH) and free thyroxine (FT4) concentrations were 2.1 µU/ml (1.12-2.95) and 0.87 µg/dl (0.77-1), respectively. Antithyroglobulin (TgAb) and antiperoxidase (TPOAb) antibody values were positive in 5.4% and 19.6%, respectively. In the bivariate analysis, iodized salt intake was associated with iodine sufficiency (OR = 3.6; 95% CI, 1.45-8.93). A total of 41.3% of women with iodized salt intake had urinary iodine levels higher than 160 µg/l compared with 16.3% of those not consuming iodized salt (p = 0.004). No association was found between iodine sufficiency and a family history of thyroid disease, the presence of goiter, levothyroxine treatment, TSH, FT3, FT4, TPOAb or TgAb. In the multivariate analysis, the adjusted OR for the association between intake of iodized salt and iodine sufficiency was 3.92 (1.46-10.53; p = 0.008). Conclusions: In this sample, 69.6% of the pregnant women showed urinary iodine levels lower than 160 µg/l. Intake of iodized salt was associated with iodine sufficiency. We found no correlation between urinary iodine levels and TSH, FT4, FT3, or antibody positivity

[Diagnostic localization of insulinoma and prognostic value of postoperative glycemia monitoring]. / Diagnóstico de localización en el insulinoma y valor pronóstico de la monitorización de la glucemia posquirúrgica.

BACKGROUND: Our purpose was to establish the efficacy of different diagnostic tests for the diagnosis and localization of insulinoma as well as the prognostic value of postoperative glycemia measurements. PATIENTS AND METHOD: Retrospective analysis of all insulinoma patients diagnosed at our hospital over the last fifteen years. Every patient underwent a supervised prolonged fasting and localization imaging tests were performed in positive cases. In the immediate preoperative period, during surgical intervention and immediately after it, an intravenous dextrose solution (10% concentration, 2-3 g/Kg/d infusion rate) was used to avoid hypoglycemia. Glycemia was measured every 6-8 h from the immediate postoperative period until hospital discharge. RESULTS: Seventeen insulinoma cases were identified (incidence 2.5 cases/million/year), 59% women and 41% men. The sensitivity (and positive predictive value) of diagnostic tests was: conventional-contrast CT scan 30% (75%), spiral CT scan 71.42% (100%), arteriography 28.57% (100%) and intraoperative ultrasonography 100% (100%). MRI identified insulinoma in two out of five patients and In-pentetreotide scintigraphy only in one out of five. Patients subsequently developing diabetes mellitus or glucose intolerance had higher levels of postoperative glycemia, which also lasted for more days, and longer need for insulin therapy. However, patients with a recurrence of the tumor did not show rebound hyperglycemia at all. CONCLUSION: Postoperative glycemia could be a useful prognostic factor in patients who develop diabetes mellitus or glucose intolerance after resection of insulinoma and to predict insulinoma recurrence.

Diagnóstico de localización en el insulinoma y valor pronóstico de la monitorización de la glucemia posquirúrgica / Diagnostic localization in insulinoma and prognostic value of postoperative glycemia measurement

FUNDAMENTO: Establecer la utilidad de los distintos métodos diagnósticos para el insulinoma en nuestro medio, así como el valor pronóstico de la glucemia y/o necesidad de insulinoterapia posquirúrgica. PACIENTES Y MÉTODO: Se trata de un estudio retrospectivo de los casos de insulinoma diagnosticados en los últimos 15 años en nuestro centro. Todos los pacientes fueron sometidos a una prueba de ayuno y se utilizaron técnicas diagnósticas de localización en los casos positivos. Inmediatamente antes de la cirugía, durante la resección del tumor y en el postoperatorio inmediato, se empleó una infusión intravenosa de suero glucosado al 10 por ciento a razón de 2-3 g/kg/día para evitar la hipoglucemia. La glucemia fue monitorizada desde el postoperatorio inmediato cada 6-8 h. RESULTADOS: Se estudiaron 17 casos (incidencia de 2,5 casos/1.000.000/año), el 59 por ciento mujeres y un 41 por ciento varones. La sensibilidad (valor predictivo positivo [VPP]) de las técnicas diagnósticas fue: tomografía computarizada (TC) con contraste, 30 por ciento (75 por ciento); TC helicoidal, 71,42 por ciento (100 por ciento), y ecografía intraoperatoria 100 por ciento (100 por ciento). La resonancia magnética (RM) sólo identificó el tumor en tres de 5 pacientes y la gammagrafía con In-pentetreótido sólo identificó el tumor en uno de 5 pacientes. La arteriografía fue necesaria en 7 pacientes, identificando el tumor en sólo dos de ellos. El cateterismo venoso selectivo fue diagnóstico en el único paciente en el que se realizó. Los pacientes que a la larga desarrollaron diabetes mellitus o intolerancia hidrocarbonada presentaron cifras mayores de hiperglucemia posquirúrgica, más días de hiperglucemia y de insulinoterapia, mientras que aquellos en los que existió recidiva del insulinoma no presentaron hiperglucemia posquirúrgica. CONCLUSIÓN: El comportamiento de la glucemia en el postoperatorio inmediato tras la resección del insulinoma puede ser útil para valorar la recidiva tumoral o la aparición de diabetes mellitus posterior (AU)