Diabetes mellitus tipo 2 descompensada y disfunción renal en paciente con trasplante cardiaco en tratamiento inmunosupresor / Uncontrolled type 2 diabetes mellitus and renal impairment in a patient with heart transplant and immunosuppressive therapy

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[Age of menopause in patients with differentiated thyroid cancer treated with radioiodine]. / Edad de menopausia en pacientes tratadas con I131 por cáncer diferenciado de tiroides.

INTRODUCTION: Differentiated thyroid cancer (DTC) is an increasingly frequent endocrinological disease. Radioiodine is a key component of treatment. OBJECTIVE: To analyze the effects of I(131) therapy on ovarian and reproductive function. MATERIAL AND METHODS: We retrospectively analyzed data from 202 women treated with radioiodine for DTC in our service from 1985-2008. Data on age at menopause in patients and their mothers and sisters, menstrual history, fertility and neonatal abnormalities were collected. RESULTS: Menopause occurred in 34 patients at follow-up. The mean age at menopause in patients was 49.94+/-3.45 while that in their mothers and sisters was 49.20+/-5.37 and 48.73+/-3.74 years, respectively. Three patients had transient amenorrhea. No infertility or neonatal alterations were found. CONCLUSIONS: In our series, menopause did not occur earlier in patients than in their first degree relatives. No significant alterations in neonatal health, fertility or menstruation were found.

Edad de menopausia en pacientes tratadas con I131 por cáncer diferenciado de tiroides / Age of menopause in patients with differentiated thyroid cancer treated with radioiodine

Introducción El cáncer diferenciado de tiroides es la neoplasia endocrina mas frecuente. El tratamiento con radioyodo es una pieza importante del tratamiento. Objetivo Analizar los efectos de esta terapia sobre la función ovárica y reproductiva en las pacientes tratadas con I131.Material y método Se realizó un análisis retrospectivo de los datos de 202 mujeres afectas de cáncer diferenciado de tiroides y tratadas con I131 en nuestro servicio entre 1985–2008. Se recogieron datos acerca de la edad de la menopausia de las pacientes y de sus madres y hermanas, historia menstrual, fertilidad y patología neonatal.Resultados34 mujeres alcanzaron la edad de menopausia durante su seguimiento, con una edad media de 49,94±3,45 años mientras que en madres y hermanas fue de 49,20±5,37 y 48,73±3,74 años, respectivamente. Tres de estas pacientes presentaron oligoamenorrea transitoria. Ninguna tuvo infertilidad ni alteraciones en la descendencia. Conclusiones En nuestra serie no se halló un adelanto significativo de la edad de la menopausia respecto a sus familiares de primer grado ni una incidencia significativa de patología neonatal, infertilidad y/o alteraciones menstruales (AU)

Introduction Differentiated thyroid cancer (DTC) is an increasingly frequent endocrinological disease. Radioiodine is a key component of treatment. Objective To analyze the effects of I131 therapy on ovarian and reproductive function. Material and methods We retrospectively analyzed data from 202 women treated with radioiodine for DTC in our service from 1985–2008. Data on age at menopause in patients and their mothers and sisters, menstrual history, fertility and neonatal abnormalities were collected. Results Menopause occurred in 34 patients at follow-up. The mean age at menopause in patients was 49.94±3.45 while that in their mothers and sisters was 49.20±5.37 and 48.73±3.74 years, respectively. Three patients had transient amenorrhea. No infertility or neonatal alterations were found. ConclusionsIn our series, menopause did not occur earlier in patients than in their first degree relatives. No significant alterations in neonatal health, fertility or menstruation were found (AU)

Utilidad de la determinación de tiroglobulina en aspirado de ganglios linfáticos de pacientes con carcinoma papilar de tiroides y anticuerpos antitiroglobulínicos positivos / Usefulness of thyroglobulin determination in lymph node aspirates of patients with papillary thyroid carcinoma and positive antithyroglobulin antibodies

Objetivo: Precisar la utilidad de la determinación de tiroglobulina (Tg)en el líquido de lavado de la aguja de citología (Tg-PAAF) en el diagnóstico de adenopatías metastásicas de pacientes con cáncer papilarde tiroides (CPT) y anticuerpos antitiroideos positivos (AbTg).Material y métodos: Estudiamos a 11 pacientes (49,9 ± 11,8 años; el70%, mujeres) con antecedentes de CPT y concentraciones de AbTgséricas positivas quienes habían recibido tratamiento con 131I y mostraron captación patológica en el cuello compatible con adenopatías metastásicas. Se realizó punción aspirativa con aguja fina (PAAF) guiada; la aguja de punción se lavó con 1 ml de suero fisiológico y se determinóla Tg. Resultados: Se detectaron 17 nódulos sospechosos y 16 de ellos mostraron concentraciones de Tg en el líquido de lavado ≥ 7 ng/ml (223,3± 314,2 [7-1.009]). No se objetivaron AbTg en ellas. El rastreo corporaltotal (RCT) detectó el 94% de las adenopatías, mediante ecografía y citología se detectaron el 76,5 y el 70,6%, respectivamente. La Tg-PAAF fue positiva en el 94% de los nódulos, con superiorioridad al conjunto de ecografía y citología (88,2%) y la suma de los hallazgos ecográficos y Tg-PAAF detectó el 100% de los ganglios. Conclusiones: La determinación de Tg-PAAF es una técnica útil para el diagnóstico de adenopatías metastásicas de CPT y no resulta afectada por la presencia de AbTg séricos (AU)

Objective: We wanted to study the utility of thyroglobulin determination in the washout of fine needle aspiration (FNABTg) of lymph metastatic nodes in patients with papilar thyroid carcinoma (PTC) and positive serum thyroglobulin antibodies (AbTg).Materials and methods: We have studied 11 patients (49.9 ± 11.8 years old,70% females) with PTC and positive AbTgin which a whole-body scanning (WBS)after 131I treatment showed pathologicaluptake in lymph cervical nodes. An ultrasound-guided fine-needle aspiration biopsy (US-FNAB) was performed for cytological research. Needle-washout with1 ml ClNa 0.9% was employed to determine FNAB-Tg. Results: In 16/17 suspicious nodes Tg-FNAB concentration was higher than 7 ng/dl (223.3 ± 314.2 [7-1009]). AbTg were negative in the washout obtained. WBS was able to detect 94%lymphadenopathies, whereas 76.5% were detected with ultrasound and 70.6% using cytology. The FNAB-Tg was positive in 94%of nodules, which was higher than combining US and FNAB-cytology both together (88.2%). One hundred per cent of pathological nodules were detected using US plus FNAB-Tg. Conclusions: FNAB-Tg determination isan useful technique for diagnosis of metastatic lymph nodes of patients with PTC and is unaffected by the presence of serum AbTg (AU)

[Usefulness of the determination of thyroglobulin in lymph node aspirates of patients with papillary thyroid carcinoma and positive antithyroglobulin antibodies]. / Utilidad de la determinación de tiroglobulina en aspirado de ganglios linfáticos de pacientes con carcinoma papilar de tiroides y anticuerpos antitiroglobulínicos positivos.

OBJECTIVE: We wanted to study the utility of thyroglobulin determination in the washout of fine needle aspiration (FNAB-Tg) of lymph metastatic nodes in patients with papillar thyroid carcinoma (PTC) and positive serum thyroglobulin antibodies (AbTg). MATERIALS AND METHODS: We have studied 11 patients (49.9+/-11.8 years old, 70% females) with PTC and positive AbTg in which a whole-body scanning (WBS) after (131)I treatment showed pathological uptake in lymph cervical nodes. An ultrasound-guided fine-needle aspiration biopsy (US-FNAB) was performed for cytological research. Needle-washout with 1 ml ClNa 0.9% was employed to determine FNAB-Tg. RESULTS: In 16/17 suspicious nodes Tg-FNAB concentration was higher than 7 ng/dl (223.3+/-314.2 [7-1009]). AbTg were negative in the washout obtained. WBS was able to detect 94% lymphadenopathies, whereas 76.5% were detected with ultrasound and 70.6% using cytology. The FNAB-Tg was positive in 94% of nodules, which was higher than combining US and FNAB-cytology both together (88.2%). One hundred per cent of pathological nodules were detected using US plus FNAB-Tg. CONCLUSIONS: FNAB-Tg determination is an useful technique for diagnosis of metastatic lymph nodes of patients with PTC and is unaffected by the presence of serum AbTg.

Recombinant-activated factor VII as hemostatic therapy in eight cases of severe hemorrhage from esophageal varices.

BACKGROUND AND AIMS: There are several treatment options for gastroesophageal variceal hemorrhage. In severe cases, bleeding persists and is associated with a dismal outcome. The coagulation disorders might be correlated with risk of bleeding in patients with portal hypertension. The administration of activated recombinant factor VII corrects prothrombin time transiently in nonbleeding patients with cirrhosis as well as in bleeding ones. The aim of this study was to assess the hemostatic efficacy of activated recombinant factor VII in bleeding esophageal varices. METHODS: Between May 2001 and September 2002, 112 patients with cirrhosis and an episode of acute esophageal variceal bleeding were admitted. On an open basis with a single intravenous dose of 4.8 mg of recombinant factor VII, we treated 8 patients experiencing severe and active hemorrhage from esophageal varices unresponsive to pharmacologic therapy, endoscopic therapy, or balloon tamponade. RESULTS: Eight (7%) of 112 patients met entry criteria. Hemostasis was achieved in all the cases after recombinant activated factor VII therapy. Rebleeding and mortality rates were 25% and 50% (2 and 4 patients), respectively. CONCLUSIONS: In our experience, recombinant activated factor VII achieves hemostasis in bleeding esophageal varices unresponsive to standard treatment.