Recomendaciones para el tratamiento farmacológicode la hiperglucemia en la diabetes tipo 2. Documento de consenso / No disponible

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Recomendaciones para el tratamiento farmacológico de la hiperglucemia en la diabetes tipo 2 / No disponible

No disponible

Técnicas diagnósticas en cardiopatía isquémica en el paciente diabético: indicaciones y algoritmo diagnóstico / Diagnostic techniques for ischemic heart disease in diabetic patients: indications and diagnostic algorithm

La hiperglucemia es un factor etiológico en la patogenia de la cardiopatíaisquémica (CI), y la presencia de diabetes, a su vez, es unimportante marcador de peor pronóstico. Cuando se diagnostica unaCI en un paciente diabético, es frecuente encontrarse una afectacióncoronaria más severa con respecto a la población no diabética. Existeuna mayor extensión y calcificación de vasos coronarios afectados,las lesiones coronarias son más complejas y se comprueba unamayor afectación del tronco principal de la coronaria izquierda. Lospacientes diabéticos se caracterizan, en ocasiones, por una presentación®atípica» de la enfermedad coronaria, lo que supone que elclínico que los valora inicialmente debe tener un alto índice de sospechadiagnóstica, con el fin de realizar el diagnóstico correctamentey, sobre todo, en el momento adecuado, cuando el paciente presentaun síndrome coronario agudo. En este artículo se analizan elpapel y el grado de evidencia científica de las técnicas diagnósticasde enfermedad coronaria en los pacientes diabéticos(AU)

Hyperglycaemia is an etiologic factor in the pathogenesis of ischemicheart disease (IHD) and the presence of diabetes, in turn, is an importantindicator of a worse prognosis. When an IHD is diagnosed ina diabetic patient the coronary disease found is frequently more severethan among the non-diabetic population. The extension andcalcification of the affected coronary vessels is greater, the coronarylesions are more complex and the damage to the left main coronary arteryis more serious. Diabetic patients are, sometimes, characterisedby an “atypical” start of the coronary disease; consequently, the generalpractitioner who carries out the initial assessment must have ahigh rate of diagnostic suspicion in order to carry out the diagnosiscorrectly and, above all, to carry it out at the appropriate time, whenthe patient first has an acute coronary syndrome. This article analysesthe role and the level of scientific evidence of the diagnostictechniques for coronary disease in diabetic patients(AU)

Evaluación de un protocolo de perfusión continua de insulina en enfermos críticos / Implementation and evaluation of a protocol for continuous insulin perfusion in critical patients

Objetivo. Analizar la eficacia y la seguridad de un protocolo de infusión continua de insulina para el control de la glucemia entre 100-140 mg/dl, evaluando los resultados mediante un método que considera todas las horas de tratamiento. Diseño. Estudio prospectivo observacional durante un período de dos meses y seguimiento hasta finalizar el tratamiento con insulina en perfusión. Ámbito. Unidad de Cuidados Intensivos polivalente de 23 camas. Pacientes. Cincuenta pacientes consecutivos mayores de 18 años con dos glucemias > 140 mg/dl distanciadas 4-6 horas. Se excluyeron los pacientes con dieta oral. Intervención. La velocidad de perfusión y la frecuencia de monitorización de la glucemia se realizaron de acuerdo con las normas del protocolo por parte del personal de enfermería. Principales variables de interés. Días de perfusión de insulina y número y valor de las glucemias realizadas. Se estudiaron los episodios de hipoglucemia, la glucemia media, el porcentaje de glucemias y de horas que el paciente estaba en cada tramo de glucemia. Resultados. La duración media del tratamiento fue 15,6 días (DE 12). Se recogieron un total de 17.768 horas y 8.111 glucemias. El 55,5% de las glucemias estuvieron entre 100-140 mg/dl, lo que representa el 63,9% de las horas. La glucemia media fue 133 mg/dl. Sólo se produjeron dos episodios de hipoglucemia severa (< 45 mg/dl). Conclusión. El protocolo fue seguro y permitió mantener un control glucémico adecuado. El análisis de todas las horas de tratamiento podría aportar más datos que el simple estudio del porcentaje de glucemias en el rango de la normalidad y la glucemia media

Objective. To analyze the efficacy and safety of a protocol for the continuous infusion of insulin to maintain blood glucose levels between 100 and 140 mg/dl, evaluating the results by a method that takes all of the hours of treatment into consideration. Design. Prospective observational study over a two-month period and follow up until the end of insulin perfusion. Context. Twenty three-bed polyvalent ICU. Patients. Fifty consecutive patients > 18 years of age with 2 episodes of glycemia > 140 mg/dl separated by 4-6 hours. Patients on an oral diet were excluded. Intervention. The perfusion rate and the frequency of glycemia monitoring were set according to the nursing staff’s protocol. Main variables of interest. Days of insulin perfusion and number and value of the blood glucose measurements taken. Episodes of hypoglycemia, mean blood glucose level, the percentage of hyperglycemia episodes, and the number of hours that the patient’s blood glucose was in each range. Results. The mean duration of treatment was 15.6 days (SD 12). A total of 17,768 hours and 8,111 blood glucose measurements were collected. 55.5% of the blood glucose measurements were between 100-140 mg/dl, and this represents 63.9% of the hours. The mean blood glucose level was 133 mg/dl. Only 2 episodes of severe hypoglycemia (< 45 mg/dl) occurred. Conclusion. The protocol was safe and enabled adequate control of blood glucose levels. The analysis of all of the hours of treatment might provide more data than a simple study of the percentages of blood glucose measurements within the normal range and the mean blood glucose level

[Implementation and evaluation of a protocol for continuous insulin perfusion in critical patients]. / Evaluación de un protocolo de perfusión continua de insulina en enfermos críticos.

OBJECTIVE: To analyze the efficacy and safety of a protocol for the continuous infusion of insulin to maintain blood glucose levels between 100 and 140 mg/dl, evaluating the results by a method that takes all of the hours of treatment into consideration. DESIGN: Prospective observational study over a two-month period and follow up until the end of insulin perfusion. CONTEXT: Twenty three-bed polyvalent ICU. PATIENTS: Fifty consecutive patients >18 years of age with 2 episodes of glycemia >140 mg/dl separated by 4-6 hours. Patients on an oral diet were excluded. INTERVENTION: The perfusion rate and the frequency of glycemia monitoring were set according to the nursing staff's protocol. MAIN VARIABLES OF INTEREST: Days of insulin perfusion and number and value of the blood glucose measurements taken. Episodes of hypoglycemia, mean blood glucose level, the percentage of hyperglycemia episodes, and the number of hours that the patient's blood glucose was in each range. RESULTS: The mean duration of treatment was 15.6 days (SD 12). A total of 17,768 hours and 8,111 blood glucose measurements were collected. 55.5% of the blood glucose measurements were between 100-140 mg/dl, and this represents 63.9% of the hours. The mean blood glucose level was 133 mg/dl. Only 2 episodes of severe hypoglycemia (<45 mg/dl) occurred. CONCLUSION: The protocol was safe and enabled adequate control of blood glucose levels. The analysis of all of the hours of treatment might provide more data than a simple study of the percentages of blood glucose measurements within the normal range and the mean blood glucose level.

Carcinoma epidermoide de mama (descripción de un caso y revisión de la literatura) / Breast epidermoid carcinoma: report of a case and review of the literature

El carcinoma epidermoide primario de mama esuna entidad muy poco frecuente. Típicamente sepresenta como un tumor cístico en la mama de grantamaño y evolución rápida. (También se caracterizapor diseminación a distancia y escasa afectaciónmetastásica en ganglios). En la mayoría de los casos,los receptores hormonales son negativos y loshallazgos radiológicos son inespecíficos. Los tratamientosdescritos en la literatura consisten en lacombinación de cirugía, quimioterapia y radioterapia

Breast primary squamous carcinoma is an infrequententity. It appears typically as a voluminousbreast cystic tumour of rapid evolution. It is characteristicthe development of a systemic disseminationgenerally in the absence of regional lymph nodemetastases. In most cases hormone receptors arelacking, and radiological findings are not specific.The treatments described in the medical literatureconsist of a combination of surgery, chemotherapyand radiotherapy

Manifestaciones electrocardiográficas en la hipotermia / Electrocaridographic manifestations of hypotermia

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[Complications of plateletpheresis procedures]. / Complicaciones de los procedimientos de tromboaferesis.

PURPOSE: Thrombopheresis procedures have been recently expanded with the development or different programmes. Taking into account that this reasonably safe procedure is not devoid of complications, it would be desirable to select those individuals with lower risk of suffering adverse side effects as donors. The thrombopheresis procedures performed in our hospital between 1986 and 1997 were analysed in order to establish the useful guidelines for such selection. MATERIAL AND METHODS: All the thrombopheresis procedures performed in the Asturias Central Hospital blood bank in the 1986-1987 period were analysed. The first procedure per donor, along with all data referred to adverse effects appearing during thrombopheresis, were collected. Sex, age, body, weight, blood cells count (before and after thrombopheresis) and serum calcium levels (before and after thrombopheresis) were taken as variables with predictive value for adverse effects. With regard to the procedure, the model of cell separator, the duration of the procedure, the amount and type of anticoagulant solution and the prophylactic use of calcium ions were assessed. RESULTS: A total number of 1,024 thrombophereses were analysed. Some types of adverse effect were seen in 259 instances (25.3%). Of these, 70.3%, were mild, 29.3% moderate and 0.4% severe. The commonest adverse effect was perioral paraesthesia. Of the different variables studied, female sex and low weight acquired predictive value with respect to the occurrence of adverse effects. Prophylactic administration of calcium did not prevent the appearance of complications. CONCLUSIONS: The thrombopheresis procedures may present adverse side effects in a high percentage of cases, which, although mostly mild, require specialised personnel for identification and management. Males weighing over 70 kg are less prone to suffer such effects. Oral administration of calcium before the apheresis does not prevent the adverse reactions.

[Treatment results with external radiotherapy in prostate cancer]. / Resultados del tratamiento con radioterapia externa en el cáncer de próstata.

OBJECTIVE: External irradiation is an accepted curative treatment modality for patients with localized prostatic tumor. The 15-year results in patients treated by radical irradiation alone are presented. The determinant prognostic factors for local tumor control and disease free survival are analyzed. METHODS: 135 patients with a histologically confirmed localized carcinoma of the prostate were treated at our department from May 1972 to January 1998. Fifty patients received Co-60 therapy; the linear accelerator and high energy photons were utilized in the remaining 80 patients. By tumor stage, 53 patients were B1, 49 B2 and 33 C. The mean follow-up was 61 months (range 1-180). Most patients were exposed to localized fields of irradiation; dose ranged from 50-74 Gy, fractionated at a dose of 180-200 cGy/day. RESULTS: Overall local tumor control was 77% at 5 years and 73% at 15 years, with a disease free survival of 63% and 45% at 5 and 15 years, respectively. Local tumor control at 13 years was 71% for stage B1, 82% for B2 and 70% for C. The disease free survival at 13 years for stages B1, B2 and C were 46%, 49% and 36%, respectively. The BD and MD tumors had a 15-year disease free survival of 48% vs 32% for the PD tumors (p = 0.005). Patients with PSA < or = 20 ng/ml before treatment showed a disease free survival of 87% vs 48% for those with PSA > 20 ng/ml ((p = 0.011). Multivariate analysis showed dose to be a determinant prognostic factor for local tumor control (0.0432); dose and histological grade were determinants for disease free survival (p = 0.029 and 0.033). CONCLUSIONS: This retrospective study found dose to be a determinant prognostic factor for local tumor control and both dose and histological grade were determinants for disease free survival. Radiotherapy is a therapeutic option for these patients. The results can be enhanced if the dose delivered to the prostate can be increased while maintaining the complication rate within the same ranges.

[Surgical treatment of atrial fibrillation]. / Tratamiento quirúrgico de la fibrilación auricular.

Atrial fibrillation is the most frequently found sustained arrhythmia. It increases the risk of thromboembolism and adversely affects cardiac performance because of loss of atrial kick. New surgical treatments of atrial fibrillation have been developed to ablate the origin of abnormal impulses on the atrium. The left atrial isolation and the corridor operation restores the regular rhythm, but do not reduce the risk of thromboembolism because the left atrium may continue to fibrillate. The maze operation has proven to be effective in both converting to sinus rhythm and regaining atrial contractility. However, this method is meticulous and time-consuming and takes more cardiac ischemic time, especially when other cardiac procedures are performed simultaneously.