Abnormalities in gallbladder dynamics of type 1 (insulin-dependent) diabetic patients with autonomic neuropathy

The aim of this study was to evaluate gallbladder dynamics in insulin-dependent diabetic patients with and without autonomic neuropathy. Gallbladder dynamics was studied by a scintigraphicmethod after a test meal in 26 insulin-dependent diabetic patients and 10 normal individuals. The presence and severity of autonomic neuropathy were defined according to the number of abnormal cardiovascular reflex tests: absent (no abnormal test), mild (1-3 abnormal tests), and severe (4-5 abnormal tests). The time from the moment when the patient started to take the test meal to the begnning of gallbladder emptying was longer (P = 0.01) in diabetic patients with mild (N = 11,12.1 ñ 7.6 min) and severe neuropathy (N = 8,11.0 ñ 10.6 min) than diabetic patients without autonomic neuropathy (N = 7,3.9 ñ 4.4 min) and controls (N = 10,4.8 ñ 4.2 min). The ejection rate was higher (P = 0.02) in the group with severe autonomic neuropathy (N = 8,5.1 ñ 3.3 percent/min) than diabetic patients with mild (N = 11,2.) ñ 1.0 percent/min) or without autonomic neuropathy (N = 7,1.8 ñ 0.8 por cento/min) and controls (N = 10,2.6 ñ 1 percent/min). Thirty-two percent of the diabetic patients with autonomic neurpathy presented increased perspiration, nausea and urgency to defecate after the ingestion of the test meal. A significant positive correlation of ejection rate with the presence of these symptoms (biserial point correlation test = 0.67,P<0.01) was also observed. These data suggest that insulin-dependent diabetic patients with autonomic neuropathy present abnormalities of gallbladder emptying that could be related to specific gastrointestinal sumptoms

Análise de fatores associados à recorrência de bócio pós-tiroidectomia / Analysis of the factors associated to recurrence of post-thyroidectomy goiter

Os fatores associados à recidiva de bócio pós-tiroidectomia por doença benigna da tiróoide ainda näo estäo completamente definidos, especialmente o uso profilático de hormônio tiroidiano. Objetivo. Determinar a prevalência, características e fatores associados à recorrência de bócio em pacientes submetidos à tiroidectomia por doença benigna. Métodos. Foram incluídos 66 pacientes, 53 mulheres e 13 homens (idade média = 51 anos, variaçäo = 20-82 anos) submetidos previamente (5,6 + or - 1 anos) à tiroidectomia (lobectomia, n = 50; nodulectomia, n = 5; tiroidectomia subtotal, n = 11). Na ocasiäo do estudo foi realizada ecografia de tiróide e dosagens séricas de T3, T4, TSH e anticorpos antimicrossomal. Definiu-se como recorrência de bócio a presença de volume residual >20mL e/ou novos nódulos >0,5mL à ecografia e näo previamente detectados durante a cirurgia. Resultados. SEte pacientes (10 por cento) apresentaram recorrência de bócio. O tempo de acompanhamento foi mais longo no grupo com recorrência (p < 0,5) e näo foi observada diferença em relaçäo a idade, sexo presença de história familiar de tiropatia e diagnóstico pré-operatório entre os dois grupos. Na análise de regressäo múltipla, apenas o tmepo de acompanhamento pós-tiroidectomia foi significativamente associado à recorrência de bócio (ß = 0,02;//2 = 0,16; p < 0,05), influenciando em 14 por cento a taxa de recorrência. História familiar de tiropatia, uso de hormônio tiroidiano e níveis séricos de T4 e TSE näo influenciaram a recorrência. Conclusäo. A recorrência de bócio pós-tiroidectomia por doença benigna de tiróide ocorre numa minoria de pacientes e estáa relacionada com o maior tempo de acompanhamento após a cirurgia. O uso de hormônio tiroidiano em doses näo supressiva após a cirurgia näo se relaciona à prevençäo de recorrência

Risk factors for development of proteinuria by type II (non-insulin dependent) diabetic patients

1. Renal involvement in non-insulin dependent diabetes mellitus patients is the single most important cause of renal failure. The aim of this study was to evaluate the clinical features and to assess the risk factors for the development of proteinuria by non-insulin dependent diabetic patients. 2. Risk factors (expressed as an odds ratio) were calculated by multiple logistic regression analysis taking into account age, sex, body mass index, known duration of diabetes, presence of arterial hypertension, fasting plasma glucose, cholesterol and triglycerides as independent variables and proteinuria as the dependent variable. Sixty-four normoalbuminuric (24-h albumin excretion rate < 30 micrograms/min, 27 females, mean age 53.7 years) and 53 proteinuric (24-h proteinuria > 0.5 g, 31 females, mean age 59.3 years) were studied. 3. Proteinuric patients were older, with a longer mean known duration of diabetes (12.4 vs 5.6 years), higher mean fasting plasma glucose (214 vs 168 mg/dl) and plasma creatinine (1.5 vs 1.1 mg/dl) and more frequently presented diabetic retinopathy (94 per cent vs 23 per cent ), peripheral neuropathy (94 per cent vs 23 per cent ) and arterial hypertension (73 per cent vs 16 per cent ) than normoalbuminuric patients. Age > 50 years, body mass index > 28.6 kg/m2, known duration of diabetes > 10 years, presence of arterial hypertension, and fasting plasma glucose > 160 mg/dl were significantly and independently associated with development of proteinuria