RESUMO
BACKGROUND: Laparoscopic adrenalectomy is considered the gold standard for the surgical treatment of adrenal disorders in most centers. This study analyzes the authors' experience using the lateral intraperitoneal approach with the first 100 patients. In addition to analyzing the authors' experience, this article aims to contrast it with some published series as an internal quality control. METHODS: In a 10-year period, 138 laparoscopic adrenalectomies were performed for 100 patients. Demographics, surgical results, complications, and long-term outcomes were analyzed. RESULTS: The participants comprised 69 women and 31 men with a mean age of 37 years. The procedures included 24 right, 38 left, and 38 bilateral adrenalectomies. The indications for surgery were Cushing's disease for 33 patients, pheochromocytoma (4 bilateral) for 23 patients, Cushing's syndrome for 18 patients, Conn's syndrome for 16 patients, and incidentaloma for 10 patients. Five procedures were converted to open surgery. Two patients with pheochromocytoma required intraoperative blood transfusion. The mean operative time was 174 min for unilateral adrenalectomies and 302 min for the bilateral procedures. The mean hospital stay was 5 days. Surgical morbidity included an abdominal wall hematoma, a small pneumothorax, and intraabominal bleeding in one patient that required reexploration. There were three operative mortalities not related to the technique. The long-term results showed control of hypercortisolism in all the patients with Cushing's disease and 82% of the patients with pheochromocytoma. Most of the patients with Conn's syndrome (91.4%) became normotensive after surgery. CONCLUSIONS: Laparoscopic adrenalectomy is safe and effective. The complications are mild, and mortality is related more to the patient's condition than to the surgical technique.
Assuntos
Doenças das Glândulas Suprarrenais/cirurgia , Adrenalectomia/métodos , Laparoscopia , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Resultado do TratamentoRESUMO
The prevalence of lipid abnormalities revealed in a survey done in 417 Mexican cities is described. Information was obtained on 15,607 subjects, aged 20 to 69 years. In this report, only samples obtained after a 9- to 12-h fast were included (2,256 cases: 953 men and 1,303 women). The population is representative of Mexican urban adults. Mean lipid concentrations were: cholesterol, 4.80 mmol/l; triglycerides, 2.39 mmol/l; HDL cholesterol, 1.00 mmol/l; and LDL cholesterol, 3.06 mmol/l. The most prevalent abnormality was HDL cholesterol below 0.9 mmol/l (46.2% for men and 28.7% for women). Hypertriglyceridemia (>2.26 mmol/l) was the second most prevalent abnormality (24.3%). Severe hypertriglyceridemia (>11.2 mmol/l) was observed in 0.42% of the population. Increased LDL cholesterol (> or =4.21 mmol/l) was observed in 11.2% of the sample. Half of the hypertriglyceridemic subjects had a mixed dyslipidemia or low HDL cholesterol. More than 50% of the low HDL cholesterol cases were not related to hypertriglyceridemia. Insulin resistance was found in 59% of them. In conclusion, the prevalence of hypoalphalipoproteinemia and other forms of dyslipidemia in Mexican adults is very high and it is among the highest previously reported worldwide.
Assuntos
HDL-Colesterol/sangue , Hiperlipidemias/epidemiologia , Adulto , Idoso , Colesterol/sangue , LDL-Colesterol/sangue , Complicações do Diabetes , Feminino , Humanos , Hipercolesterolemia/sangue , Hipercolesterolemia/epidemiologia , Hiperlipidemias/sangue , Hiperlipidemias/complicações , Hipertensão/complicações , Hipertrigliceridemia/sangue , Hipertrigliceridemia/epidemiologia , Lipoproteínas HDL/sangue , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Fenótipo , Triglicerídeos/sangueRESUMO
Conflicting results have been published during the past three decades regarding the cut points for the diagnosis of diabetes and glucose intolerance. Two major consensus changed the diagnostic values; the last revision occurred in 1997. After the publication of the new criteria, the controversy grew. New evidence was published demonstrating that the new cut points were inappropriate. The purpose of this review paper is to summarize the currently available information useful to evaluate the sensibility and specificity of the diagnostic criteria and to discuss the difficulties to define properly the cut-points for the diagnosis of diabetes and glucose intolerance.
Assuntos
Diabetes Mellitus Tipo 2/diagnóstico , Teste de Tolerância a Glucose , Estado Pré-Diabético/diagnóstico , Idoso , Glicemia/análise , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/genética , Nefropatias Diabéticas/epidemiologia , Retinopatia Diabética/epidemiologia , Jejum/sangue , Feminino , Humanos , Resistência à Insulina , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Estado Pré-Diabético/sangue , Estado Pré-Diabético/epidemiologia , Estado Pré-Diabético/genética , Prevalência , Valores de Referência , Reprodutibilidade dos Testes , Fatores de Risco , Sociedades Médicas , Estados Unidos , Organização Mundial da SaúdeRESUMO
INTRODUCTION: Insulinomas are uncommon tumors, their incidence is approximately one case for 1 million population per year. OBJECTIVE: To expose our experience in the diagnosis of these tumors at the Instituto Nacional de la Nutrición Salvador Zubirán. MATERIAL AND METHODS: All patients with histologic diagnosis of insulinoma were reviewed; the period was from 1959 to 1996. The methods used for diagnosis and localization as well as the clinical picture according to the benignity or malignity of the tumor were registered. RESULTS: Eighteen patients were included, four of them with malignant tumors. In two patients islet cell tumors occurred in association with MEN type I, one of them benign and the other malignant. The mean age of patients with benign tumor was 38.2 +/- 13.5 years, in those with malignant tumors it was 51.5 +/- 16.2 years. The median period between symptoms and diagnosis was 34.4 +/- 15 months for benign tumors and 6 +/- 1.1 months for those with malignant tumors (p = 0.02). Patients with increasing weight had benign tumors. The 24 hours fasting test was not done in patients with malignant tumors because of the severity of hypoglycemia. The insulin/glucose ratio in patients with a malignant tumor was 5.2 +/- 4.7, while in patients with a benign tumor it was 1.82 +/- 1.7. The imaging studies showed that three patients with malignant tumors had hepatic metastasis and one had lymph node metastasis. The low accuracy of localization by radiological methods is due to the size of the tumor (> 2 cm). CONCLUSIONS: Malignant insulinomas are more aggressive and the delay of diagnosis is shorter that in cases with benign tumors. Selective arteriography remains the best preoperative localization procedure.
Assuntos
Insulinoma/diagnóstico , Neoplasias Pancreáticas/diagnóstico , Adenoma de Células das Ilhotas Pancreáticas/diagnóstico , Adulto , Feminino , Órgãos Governamentais , Humanos , Masculino , México , Pessoa de Meia-IdadeRESUMO
Morbid obesity is a health hazard. It carries several health risks and decreases life expectancy. Individuals with morbid obesity may develop one or more complications. These are mainly cardiovascular, metabolic, respiratory, gastrointestinal, renal, genitourinary and gynaecological. Patients with morbid obesity also have a high surgical risk. This review analyses the most common complications of morbidly obese patients and their changes after surgically induced weight loss.
Assuntos
Obesidade Mórbida/complicações , Feminino , Doenças Urogenitais Femininas/etiologia , Gastroenteropatias/etiologia , Cardiopatias/etiologia , Humanos , Nefropatias/etiologia , Expectativa de Vida , Masculino , Doenças Urogenitais Masculinas , Doenças Metabólicas/etiologia , Obesidade Mórbida/cirurgia , Doenças Respiratórias/etiologia , Fatores de Risco , Redução de PesoRESUMO
The apolipoprotein E4 allele is associated in industrialized countries with an elevated LDL cholesterol concentration and an increased cardiovascular risk. Our purpose in this study was to assess the influence of the genetic variation at the APOE gene locus on the lipid profile of a Native American rural population. We examined plasma lipid levels and the common apo E alleles in 142 healthy randomly selected adults living in their native communities in western Mexico. Their age was 38+/-17 years and the BMI 25.7+/-4.5 kg/m2. Plasma cholesterol, triglycerides, LDL C and HDL C were 165+/-29.6, 126+/-83, 98+/-26 and 42+/-12.7 mg/dl respectively. Ninety-one per cent of the subjects had Lp(a) concentrations below 20 mg/dl and 30% had levels lower than 2 mg/dl. The most common APOE genotype was E3/3 (63%), followed by E3/4 (30.1%). The prevalence of the E2 allele was very low (2.3%). No difference was observed in LDL C concentrations between the E3/E3 and E3/E4 subjects; however carriers of the E2/3 genotype had lower LDL C levels. Similar results were obtained for cholesterol and apo B levels. In summary, the increased LDL C levels associated with the E4 allele in previous studies were not observed in a population with non-westernized habits. Environmental factors, such as diet and lifestyle, could outweigh the hypercholesterolemic predisposition resulting from the presence of the apo E4 allele.
Assuntos
Alelos , Apolipoproteínas E/genética , Indígenas Norte-Americanos/genética , Estilo de Vida , Lipídeos/sangue , Adulto , Apolipoproteína E4 , Apolipoproteínas E/sangue , Feminino , Genótipo , Humanos , Hipercolesterolemia/sangue , Hipercolesterolemia/etnologia , Hipercolesterolemia/genética , Masculino , México/epidemiologia , Distribuição Aleatória , Valores de Referência , Fatores de Risco , População RuralRESUMO
OBJECTIVE: To study the concordance between the 1997 American Diabetes Association (ADA) impaired fasting glucose (IFG) category with the World Health Organization (WHO) impaired glucose tolerance (IGT) status in a population with a high prevalence of diabetes. RESEARCH DESIGN AND METHODS: We analyzed the oral glucose tolerance tests (OGTTs) carried out at the Instituto Nacional de la Nutrición Salvador Zubiran (INNSZ) central laboratory from June to December 1997. We included patients with fasting plasma glucose (FPG) between 60 and 160 mg/dl. The results from the glucose tolerance test were selected as the gold standard. RESULTS: Among the 1,802 glucose tolerance test results available for analysis, 1,706 fulfilled the requirements to be included. Diabetes and IGT were remarkably more frequently diagnosed when the WHO criteria were applied. The new ADA criteria failed to diagnose 69% of WHO diabetic patients and the vast majority of WHO glucose-intolerant subjects. Using the new criteria, 82% were considered normal. Of the IFG subjects, 39% were classified as diabetic and 23% were normal according to the 2-h postchallenge glucose values. Only 37% of the IFG patients were, in fact, glucose intolerant according to the WHO criteria. CONCLUSIONS: Our results clearly show that the 1997 ADA criteria are less sensitive for diagnosing diabetes than OGTT-based WHO criteria. Even more important, there is poor agreement between the WHO category of IGT and the ADA category of IFG.
Assuntos
Diabetes Mellitus/diagnóstico , Teste de Tolerância a Glucose/normas , Instituições Filantrópicas de Saúde/normas , Organização Mundial da Saúde , Adulto , Estudos Transversais , Diabetes Mellitus/epidemiologia , Jejum , Feminino , Humanos , Masculino , Prevalência , Padrões de Referência , Fatores de RiscoRESUMO
Parathyroid carcinoma is a rare cause of primary hyperparathyroidism with a prevalence ranging between 0.5 and 4%. Because of their aggressiveness, prompt diagnosis and treatment are mandatory. A parathyroid carcinoma was found in four patients (4.5%) of 88 patients who underwent surgical cervical exploration for primary hyperparathyroidism at the Institute Nacional de la Nutrición in a period of seven years. Our paper gives the clinical characteristics, diagnosis, treatment and outcome of the four patients.
Assuntos
Hiperparatireoidismo/etiologia , Neoplasias das Paratireoides/complicações , Adulto , Feminino , Humanos , Hiperparatireoidismo/patologia , Hiperparatireoidismo/cirurgia , Masculino , Pessoa de Meia-Idade , Neoplasias das Paratireoides/patologia , Neoplasias das Paratireoides/cirurgia , Resultado do TratamentoRESUMO
Morbidly obese patients are at increased risk for structural and functional abnormalities of the heart. This paper summarizes the effects of obesity on the heart, the effect of weight reduction on cardiac function, the impact of coronary artery disease on cardiac cardiomyopathy, and our experience in obesity heart disease at the Instituto Nacional de la Nutrición in Mexico.
Assuntos
Cardiomiopatias/etiologia , Doença das Coronárias/etiologia , Obesidade Mórbida/complicações , Hemodinâmica , Humanos , Hipertensão/etiologia , Pessoa de Meia-Idade , Obesidade Mórbida/fisiopatologia , Estudos Prospectivos , Redução de PesoRESUMO
AIM: To analyze the general characteristics and outcome of laparoscopic adrenalectomy in our institution. METHODS: The clinical and intraoperative characteristics, complications and outcome of 29 consecutive patients undergoing lateral transperitoneal laparoscopic adrenalectomy between February 1995 and January 1998 were analyzed. RESULTS: Their mean age was 34 +/- 11 years, 6 were males and 23 females. The most common preoperative diagnosis was recurrent Cushing's disease followed by functioning adenomas and pheochromocytomas. There were 17 unilateral and 12 bilateral adrenalectomies. The mean operative time was 2.5 +/- 1 hours for each gland. Two patients were converted to the open technique. There were two complications: a wound infection and a postsurgery hypoglycemia. The hypoglycemic patient also developed massive upper gastrointestinal bleeding 18 days after surgery and died. The mean postoperative hospital stay was 5 days. In a mean follow-up of one year, recurrence of one pheochromocytoma was seen. CONCLUSION: Laparoscopic adrenalectomy was a safe operation that favored early recovery.
Assuntos
Adrenalectomia/métodos , Laparoscopia/métodos , Adulto , Feminino , Humanos , Masculino , MéxicoRESUMO
In most centers only selected patients with high risk thyroid nodules undergo thyroid surgery, and fine needle aspiration biopsy (FNA) is used to select patients for surgical treatment. The aim of the present study was to evaluate the impact of FNA on the management of thyroid nodules at our institution. A total of 872 patients who underwent FNA over a period of 7 years were retrospectively analyzed. There were 66 men and 806 women with a mean age of 40 +/- 15 years. Altogether 549 patients presented with a thyroid nodule and 323 with multinodular disease. The sensitivity and specificity of FNA were 90.0% and 99.8%, respectively. The positive and negative predictive values were 98% and 99%, respectively, and the accuracy was 99%. Our results are in agreement with those of other reports establishing that FNA of the thyroid is safe, reliable, and effective for differentiating benign from malignant nodules.
Assuntos
Neoplasias da Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgia , Nódulo da Glândula Tireoide/cirurgia , Tireoidectomia , Resultado do TratamentoRESUMO
BACKGROUND: Primary hyperparathyroidism (HPT) is a common endocrine disease treated very effectively by surgery. There have been changes in the management of parathyroid surgery in our hospital: since 1991, all patients have been treated by a service of endocrine surgery. OBJECTIVE: To analyze the outcome of the first 50 patients treated in the endocrine surgery service. METHODS: A prospective analysis of clinical characteristics, laboratory studies, intraoperative findings, surgical complications and outcome of 50 patients with primary HPT seen between July 1991 and March 1994 was performed. RESULTS: Ten patients were male and 40 female with a mean age of 53 years. A parathyroid adenoma was found in 43 patients, a parathyroid hyperplasia in five, a double adenoma in one and an adenoma in a supernumerary gland in one patient. Surgical cure of the disease was achieved in 96% of the patients after one surgical procedure and in 100% during the same hospital stay after repeat cervical exploration. CONCLUSIONS: Our results support the use of surgical cervical exploration in the treatment of primary HPT.
Assuntos
Adenoma/cirurgia , Hiperparatireoidismo/cirurgia , Neoplasias das Paratireoides/cirurgia , Paratireoidectomia , Adenoma/sangue , Adenoma/complicações , Adenoma/diagnóstico por imagem , Doenças Ósseas Metabólicas/etiologia , Coristoma/patologia , Coristoma/cirurgia , Feminino , Humanos , Hipercalcemia/etiologia , Hiperparatireoidismo/sangue , Hiperparatireoidismo/etiologia , Hiperplasia , Hipoparatireoidismo/etiologia , Masculino , Pessoa de Meia-Idade , Pescoço , Glândulas Paratireoides/anormalidades , Glândulas Paratireoides/diagnóstico por imagem , Glândulas Paratireoides/patologia , Glândulas Paratireoides/cirurgia , Neoplasias das Paratireoides/sangue , Neoplasias das Paratireoides/complicações , Neoplasias das Paratireoides/diagnóstico por imagem , Equipe de Assistência ao Paciente , Complicações Pós-Operatórias , Estudos Prospectivos , Resultado do Tratamento , Ultrassonografia , Cálculos Urinários/etiologiaRESUMO
BACKGROUND: Surgical treatment is the first option for patients with obstructive multinodular goiter. The extent of the resection and the use of postoperative hormonal therapy are, on the other hand, still under debate. OBJECTIVE: To analyze the results of surgical treatment in 101 patient with multinodular goiter seen from 1980 to 1995. MATERIALS AND METHODS: The clinical/pathologic charts of all patients were reviewed with emphasis to the clinical diagnosis, extent of resection, final histology, type and number of complications, and long-term follow-up. The mean follow-up was three years (range 0.5-12). RESULTS: Ten males and 91 females with a mean age of 46 years were included. Surgery was recommended for a nodule suspicious of malignancy in 60 patients, for airway compression in 33, and for cosmetic reasons in eight. Unilateral lobectomy was performed in 30, bilateral subtotal thyroidectomy in 55 and total thyroidectomy in 16. Postoperative hormone therapy was administrated to 83 patients. Surgical complications occurred in six patients. Four developed permanent hypoparathyroidism and two vocal cord paralysis. There was no operative mortality. A final diagnosis of multinodular goiter was established in 89 whereas 12 had cancer. There were three asymptomatic recurrences in the group with benign lesions (they had undergone unilateral lobectomy followed by hormonal therapy). CONCLUSION: Bilateral subtotal thyroidectomy was the best treatment for multinodular goiter in our series. This procedure had few complications and there was no recurrence of the disease.
Assuntos
Bócio Nodular/cirurgia , Tireoidectomia , Adolescente , Adulto , Idoso , Biópsia por Agulha , Carcinoma/diagnóstico , Carcinoma/epidemiologia , Carcinoma/cirurgia , Carcinoma Medular/diagnóstico , Carcinoma Medular/epidemiologia , Carcinoma Medular/cirurgia , Carcinoma Papilar/diagnóstico , Carcinoma Papilar/epidemiologia , Carcinoma Papilar/cirurgia , Feminino , Bócio Nodular/complicações , Bócio Nodular/epidemiologia , Humanos , Hipotireoidismo/tratamento farmacológico , Hipotireoidismo/etiologia , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Recidiva , Estudos Retrospectivos , Hormônios Tireóideos/uso terapêutico , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/epidemiologia , Neoplasias da Glândula Tireoide/cirurgia , Nódulo da Glândula Tireoide/diagnóstico , Tireoidectomia/métodos , Resultado do TratamentoRESUMO
BACKGROUND: Anaplastic thyroid carcinoma (ATC) is a highly aggressive tumor with a median survival rate of 6 months. AIM: To analyze presentation, treatment, morphology, immunohistochemistry, and nuclear DNA analysis of a cohort of patients with ATC. PATIENTS AND METHODS: Twelve patients with ATC (11 female) with a mean age of 65 years were seen at our hospital from 1970-1995. The data were obtained from the clinical records and the morphology, immunohistochemic studies and DNA pattern were performed in slides obtained from archival specimens. RESULTS: Previous or coexisting thyroide disease was documented in 10 patients (9 multinodular goiters and one Grave's). The most frequent presentation was a rapidly growing tumor associated with dysphagia, cervical pain, hoarseness and dyspnea. A cold thyroid nodule was detected by thyroid scan in 10 patients. The most frequent subtype was the spindle cell variety. Papillary thyroid carcinoma coexisted in eight cases, two of them corresponded to the tall cell variant. Reactivity for S-100 protein and vimentin was studied in six patients: all were positive for S-100 protein and vimentin, 5/6 for epithelial membrane antigen, half for carcinoembriogenic antigen, 2/6 for thyroglobulin and calcitonin, and one for neuronal specific enolase. These six tumors showed a diploid DNA pattern. Tumor resection was achieved in 2/11 and none survived six years after diagnosis. CONCLUSIONS: ATC is a highly aggressive tumor coexisting with thyroid pathologies. Spindle cell variant is the most frequent with positive reactivity for S-100 protein, vimentin and epithelial membrane antigen. Most tumors have a diploid DNA content.
Assuntos
Carcinoma/epidemiologia , Neoplasias da Glândula Tireoide/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/análise , Carcinoma/diagnóstico , Carcinoma/genética , Carcinoma/patologia , Carcinoma/terapia , Carcinoma Papilar/epidemiologia , Quimioterapia Adjuvante , Estudos de Coortes , Terapia Combinada , DNA de Neoplasias/genética , Feminino , Humanos , Radioisótopos do Iodo/uso terapêutico , Tábuas de Vida , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Invasividade Neoplásica , Neoplasias Primárias Múltiplas/epidemiologia , Radioterapia Adjuvante , Estudos Retrospectivos , Análise de Sobrevida , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/genética , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/terapia , Tireoidectomia , Resultado do TratamentoRESUMO
OBJECTIVE: To analyze characteristics of patients with endocrine tumors of the pancreas seen between 1960 and 1992 at the Instituto Nacional de la Nutrición. MATERIAL & METHODS: The clinical records of 38 patients with endocrine tumors of the pancreas were reviewed. Overall characteristics, diagnostic studies, intraoperative findings, treatment and outcome were analyzed. The archival histological specimens were revised and immunohistochemical stainings were performed in the non-functioning tumors. RESULTS: Twenty patients had hyperinsulinism, 10 non-functioning tumors, and eight a Zollinger-Ellison syndrome. The mean age of patients with hyperinsulinism was 38 years (8 males and 12 females); 18 were sporadic and two associated with MEN I syndrome. In 16 patients an insulinoma was removed: (6 in the head, 5 in the body, 5 in the tail of the pancreas). A cure was documented in 14 patients with sporadic tumors but not in the two cases associated with MEN I; 15 tumors were benign. Three patients with the Zollinger-Ellison syndrome were males and five females with a mean age of 41 years. Seven tumors were sporadic and one associated with the MEN I syndrome; 70% were located in the gastrinoma triangle. Local excision was performed in five and gastrectomy in three. The cure rate was 60% and malignancy was documented in 40%. Two males and eight females with a mean age of 30 years had non-functioning tumors (9 sporadic and one associated to MEN I). There was a positive immunohistochemistry in 60% of the tumors; 90% were malignant and the cure rate was 10%. CONCLUSIONS: Insulinoma is the most common endocrine tumor of the pancreas in our hospital. The cure rate for insulinomas, gastrinomas and non-functioning tumors was 90%, 60% and 10% and malignancy was documented in 5%, 40% and 90% respectively.
Assuntos
Gastrinoma , Insulinoma , Neoplasias Pancreáticas , Adulto , Feminino , Gastrinoma/complicações , Gastrinoma/diagnóstico , Gastrinoma/epidemiologia , Gastrinoma/terapia , Hospitais , Humanos , Hiperinsulinismo/epidemiologia , Hiperinsulinismo/etiologia , Insulinoma/complicações , Insulinoma/diagnóstico , Insulinoma/epidemiologia , Insulinoma/terapia , Masculino , México , Pessoa de Meia-Idade , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/epidemiologia , Neoplasias Pancreáticas/terapia , Estudos RetrospectivosRESUMO
OBJECTIVE: To examine the effects of vitamin E on total serum protein glycation (fructosamine), hemoglobin glycation (HbA1c), and serum levels of glucose, total cholesterol, triglycerides, LDL-C, HDL-C, apolipoprotein A1 and apolipoprotein B. MATERIAL AND METHODS: Sixty poorly controlled diabetic patients were randomly assigned to receive either 1200 mg/day of vitamin E or identical placebo capsules during a two month period following a double blind cross-over design with a four week wash-out period between regimens. RESULTS: Seven patients were excluded from the study because of reasons not related to the medication. In the remaining 53 patients, the levels of serum glucose, fructosamine, HbA1c, total cholesterol, HDL-C, LDL-C, Apo A1 and Apo B did not vary significantly with vitamin E as compared with placebo. CONCLUSIONS: No significant effects of vitamin E on any of the parameters evaluated were observed in poorly controlled diabetic patients.
Assuntos
Diabetes Mellitus/tratamento farmacológico , Frutosamina/sangue , Hemoglobinas Glicadas/análise , Vitamina E/uso terapêutico , Idoso , Glicemia/análise , Estudos Cross-Over , Diabetes Mellitus/sangue , Método Duplo-Cego , Feminino , Humanos , Lipoproteínas/sangue , Masculino , Pessoa de Meia-Idade , Triglicerídeos/sangue , Vitamina E/farmacologiaRESUMO
We compared the safety, tolerability and efficacy of the HMGCoA reductase inhibitor pravastatin and probucol in the treatment of patients with primary hypercholesterolemia using an active, drug controlled, double blind, randomized, double placebo design. Patients were included if LDL-C levels after a minimum of six weeks on an AHA phase I diet were greater than 150 mg/dL and triglycerides were less than 350 mg/dL. Included patients were randomly assigned to either pravastatin 40 mg pm or probucol 500 mg bi. They also received matching placebos for each drug. The active drug period lasted 16 weeks, during which the patients were seen at 4, 8, 12 and 16 weeks after baseline. There were no significant differences in baseline values between both treatment groups. Significantly lower values of total cholesterol and LDL-C were observed with pravastatin as compared to probucol. While a non significant increase of HDL-C was observed with pravastatin, a remarkable and statistically significant decrease was observed with probucol. A large dispersion of triglycerides levels was observed with both drugs and no statistically significant changes were demonstrated. Both pravastatin and probucol were well tolerated: only minimal clinical and laboratory changes, not considered to have been drug-related, were observed. No changes, considered drug-related, were observed in the cristalline lens. This study shows an overall superiority of pravastatin over probucol with significant larger decreases of total cholesterol and LDL-C and a better effect on HDL-C.
Assuntos
Hipercolesterolemia/tratamento farmacológico , Pravastatina/uso terapêutico , Probucol/uso terapêutico , Método Duplo-Cego , Feminino , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases , Hipercolesterolemia/sangue , Masculino , Pessoa de Meia-Idade , Pravastatina/efeitos adversos , Probucol/efeitos adversosRESUMO
Oral acarbose, a competitive inhibitor of alpha-glucosidase, has been shown to be effective in decreasing the postprandial rise in blood glucose and insulin. A double blind, cross-over, placebo controlled, randomized study in poorly controlled, non-insulin dependent diabetic patients under treatment with sulfonylureas was carried out. The patients continued receiving sulfonylureas throughout the study period and were randomly allocated into two sequences. In sequence A they received 100 mg tablets tid during 12 weeks; placebo tid during 2 weeks (wash-out period) and finally they were crossed over to placebo tid during 12 weeks. In sequence B, they received placebo tid 12 weeks, placebo tid during 2 weeks and finally acarbose 100 mg tid during 12 weeks. Sixteen patients were included in each sequence; three were excluded from sequence A, one because of side effects, one because of severe neuropathy and one because of change of address. One was excluded from sequence B because of failure to take the sulfonylurea. A slight but statistically significant decrease in weight was observed with acarbose as compared with placebo in both sequences. Significant reductions in postprandial glucose were observed in both sequences with acarbose. Significant reductions in fasting blood glucose were also observed in some visits. Although lower mean values of triglycerides and HbA1c were observed with acarbose, they were not statistically significant. Acarbose had side effects almost in all patients, but decreased on continued therapy. Only one patient had to be excluded for this cause. Acarbose is a useful therapeutic resource in poorly controlled non-insulin dependent diabetic patients in combination with sulfonylureas.
Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Trissacarídeos/uso terapêutico , Acarbose , Sequência de Carboidratos , Método Duplo-Cego , Avaliação de Medicamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dados de Sequência MolecularRESUMO
OBJECTIVES: To determine the effectiveness of the combination therapy with daytime chlorpropamide-metformin and bedtime NPH insulin in the treatment of secondary failures in NIDDM and to study its effects on insulin secretion. DESIGN: Non randomized open study with a duration of two months. The patients were followed six months after ending the study. INSTITUTION: Department of Diabetes and Lipid Metabolism. Instituto Nacional de la Nutrición "Salvador Zubirán", Mexico City. CHARACTERISTICS OF THE PATIENTS: Nine patients (seven women and two men) were included. All had NIDDM and secondary failure to antidiabetic oral drugs. Their fasting plasma glucose was 14.5 +/- 2 mM/L and their HbA1c 13.37 +/- 2.9%. At the entry and at the end of the study a 5h-OGTT was done with assays of plasma glucose and C-peptide. TREATMENT: Chlorpropamide (375 mg/day) plus metformin (1200 mg/day) and bedtime insulin (0.1 U/kg/day). RESULTS: After two months on combination therapy, fasting plasma glucose and HbA1c levels were remarkably improved (decreases of 7.3 +/- 0.6 and 9.1 +/- 1.02 respectively, p less than 0.002). The insulin dose was small (6.77 +/- 2.09 U/day). Side effects were minimal and infrequent. During the 5h-OGTT, the mean glucose area under the curve also decreased. The insulin secretion did not change but the C-peptide/glucose ratio increased. At the end of the study, the insulin dose was tapered off and stopped when possible. The four patients with the best glycemic control during the study were able to suspend the bedtime insulin and maintain a good control six months after the insulin suspension. CONCLUSIONS: The combination therapy is useful in the treatment of secondary failures in NIDDM: Its advantages are the very low mean daily insulin dose needed, the low incidence of side effects and, if a HbA1c less than 8.7% is achieved, the restoration of oral antidiabetic drugs efficacy. The very low insulin dose used in this study could be explained by complementary effects of metformin and bedtime insulin on hepatic glucose output and a putative decrease in peripheral resistance attributable both to sulfonylurea and metformin.