[Arterial hypertension during pregnancy: Always preeclampsia?] / Hipertensión arterial durante el embarazo: ¿siempre preeclampsia?

Cushing's syndrome is a rare condition during pregnancy, but it is associated with serious maternal and fetal complications. The most common etiology during pregnancy is the presence of an adrenocortical adenoma. Urinary free cortisol over 3 times the upper limit of normal usually indicates Cushing's syndrome during pregnancy. The treatment of choice is surgical, and the ideal time for surgery is before the third trimester.

Error fatal en prescripción medicamentosa / No disponible

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Usefulness of total cholesterol/HDL-cholesterol ratio in the management of diabetic dyslipidaemia.

AIMS: Our aim was to evaluate the usefulness of the total cholesterol/HDL-cholesterol ratio (TC/HDL) in predicting the cardiovascular risk of Type 2 diabetic patients. METHODS: Prospective cohort study with inclusion of 418 Type 2 diabetic individuals with follow-up until the appearance of a cardiovascular event. The predictive power of updated mean lipid values during follow-up was analysed by means of Cox proportional hazard models. An estimate was made of the relative risk (RR) conferred by high levels of TC/HDL stratified by LDL-cholesterol levels. RESULTS: Sixty-six cardiovascular events occurred during an average follow-up of 4.7 years (sd 1.5). The main lipid predictor of vascular events was mean TC/HDL ratio [hazard ratio (HR) = 1.46; 95% confidence interval (CI) 1.25, 1.7; P < 0.0001]. In the multivariate model with simultaneous inclusion of mean TC/HDL and mean LDL-cholesterol, both were significant predictors of cardiovascular disease [HR (1 unit) = 1.37; 95% CI 1.16, 1.62; P = 0.0003 and HR (1 mmol/l) = 1.5; 95% CI 1.04, 2.18; P = 0.03, respectively]. The LDL adjusted RR for cardiovascular events due to high TC/HDL ratio, with 4.5 cut-off point, was 2.5 (95% CI 1.4, 4.3; P = 0.0007). For the stratum of subjects with average LDL cholesterol < 3.5 mmol/l, RR was 1.2 (95% CI 0.5, 2.8; P = NS) and for the stratum of average LDL cholesterol > 3.5 mmol/l, RR was 4 (95% CI 1.8, 9; P = 0.00013), with heterogeneity among strata (P = 0.044). CONCLUSIONS: It could be useful to include the TC/HDL ratio in treatment guides for diabetic dyslipidaemia, given their high predictive value and strong interaction with LDL cholesterol.

Soporte nutricional en un paciente con síndrome de intestino corto secundario a enteritis rádica / Nutritional support in a patient with a short bowel syndrome by radiation enteritis

El síndrome de intestino corto se caracteriza por un cuadro clínico que describe las consecuencias metabólicas y nutricionales que ocurren tras una resección masiva de intestino delgado. El pronóstico depende de la longitud y segmento intestinal resecado, presencia o ausencia de la válvula ileocecal y colon, existencia de enfermedad intestinal subyacente y capacidad de adaptación del intestino remanente. Resecciones de intestino delgado superiores al 75 por ciento provocan un cuadro de malabsorción grave con compromiso nutricional que a menudo requiere el uso de nutrición parenteral a largo plazo. La exposición de la mucosa intestinal a los nutrientes intraluminales es uno de los principales mecanismos implicados en la respuesta adaptativa del intestino remanente. Presentamos el caso de un síndrome de intestino corto con un remanente intestinal afectado por enteritis rádica y con una longitud de 100 cm de yeyuno proximal y 30 cm de colon transverso/descendente. Tras un período 18 meses, en los que el paciente precisó nutrición parenteral domiciliaria para mantener su estado nutricional, se consiguió la adaptación del intestino remanente y en la actualidad sus requerimientos nutricionales se hallan cubiertos con un soporte nutricional por vía oral (AU)

[Lipid metabolism and new dietetic recommendations in diabetes mellitus]. / Metabolismo lipídico y nuevas recomendaciones dietéticas en diabetes mellitus.

Abnormalities of plasma lipids are highly prevalent in both types of diabetes, but there are important quantitative and qualitative differences that this paper reviews. The importance of abnormalities in lipoprotein metabolism as determinant of vascular risk in general population is similar in diabetes, where there is chronic hyperglycemia associated, but it is considered as an independent vascular risk factor. People with IDDM in adequate glycemic control generally have plasma lipid concentrations in normal levels, but in NIDDM, even in good glycemic control, there are another factors associated and usually there are hypertriglyceridemia and total hypercholesterolemia with reduced HDL fraction. Carbohydrate-rich diet increase plasma triglyceride levels and low HDL-cholesterol levels in the majority of studies. Substitute monounsaturated fats in the diet to replace saturated fats lowers total cholesterol and LDL fraction and increase HDL, in addition it acts over others vascular risk factors. These findings were taken into account by ADA and recently revises their 1986 dietary recommendations with the same goals of medical nutrition therapy but with individualized approach appropriate for the personal life style to facilitate adherence to achieve the glycemic, lipid body weight and blood pressure aims with a good quality of live.

[Lipid profile in diabetic patients, according to changes in glucose control: a 2-year study]. / Esquema lipídico en pacientes diabéticos, según las variaciones del control glucídico: estudio de dos años.

Disorders of the lipoprotein metabolism in diabetic patients are of great interest because their association to the presence of atheromatosis and because cardiovascular diseases are the major cause of mortality in diabetic patients. The aim of this study was to compare the lipidic scheme of our diabetic patients according to the type of diabetes, the age of onset and the evolution over the years, and to analyze the impact of variations in the glycemic control on such lipidic scheme. In the insulin-dependent diabetes mellitus, total cholesterol, LDL, HDL and triglycerides were within the recommended values for the age of the patients. There was a significant correlation between glycemia and HbAlc and triglycerides, total cholesterol and its LDL and HDL fractions. In non-insulin-dependent diabetes mellitus, we observed average values of total cholesterol and LDL fraction higher than what is recommended for diabetic patients with the characteristics of this group. There was a significant correlation between basal glycemia, HbAlc and triglycerides, as in the insulin-dependent diabetes, although there was no correlation with total cholesterol and HDL. This absence of correlation may be due to the effect of other factors: age, inadequate dietary follow-up obesity and hyperinsulinism.

[Hip algodystrophy and pregnancy]. / Algodistrofia de cadera y embarazo.

Pregnancy is a potential cause of hip algodystrophy. Mechanical loco-regional factors, as well as other potential factors, can explain this preference for the hip. This pathology must be always kept in mind when attending a pregnant patient or a patient with inguino-crural pain and functional impotence during the postpartum.