Clinical features, diagnosis and therapy of pituicytoma: an update.

BACKGROUND: Pituicytomas (PTs) are extremely rare, low-grade glial tumors closely related to the neurohypophyseal axis. Definite conclusions concerning the optimal diagnostic and therapeutic approach to these neoplasms are lacking to date, as most of this information has been presented as case reports. METHODS: Retrospective review of case reports published in the scientific literature to date, including a new illustrative example treated in our department. RESULTS: 116 cases were collected. PTs had a higher prevalence in the fifth and sixth decades of life, with a slight male predominance. Main symptoms, which tended to be progressive, included visual field defects and pituitary-hypothalamic dysfunction. Radiologically, PTs were found anywhere along the hypothalamic-pituitary axis mimicking other, more frequent tumors growing in this anatomical region. Surgical treatment included both transcranial or transsphenoidal approaches, and resulted in gross total resection and morbidity rates of 46.8 and 59%, respectively; the latter essentially consisted in anterior and posterior pituitary dysfunction, with limited impact on daily quality of life. CONCLUSIONS: Due to both low frequency and the absence of pathognomonic clinical and/or radiological features, formulating a suspicion diagnosis of PT represents a considerable challenge even for experienced professionals. The indication for treatment should be made on an individual basis, but it is inescapable in the presence of a visual field defect. The surgical approach has to be tailored according to the topography of the tumor and preoperative symptoms; the greatest challenges in accomplishing a gross total removal are represented by the degree of adherence and vascularization of the PT.

[Influence of weight loss in the clinical evolution, metabolic and psychological of the patients with overweight or obesity]. / Influencia de la pérdida de peso en la evolución clínica, metabólica y psicológica de los pacientes con sobrepeso u obesidad.

INTRODUCTION AND OBJECTIVE: The clinical evolution and psychological well-being of patients with overweight or obesity is still a matter of controversy. The aim of this study is to know the impact of the loss of weight on the evolution of the alterations both clinical and metabolic as psychological in patients with overweight or obesity. PATIENTS AND METHOD: We studied a cohort of 192 patients randomly chosen. All of them were characterized clinically and biochemically. Autoadministered questionnaires were used which were already validated in the Spanish population:the General Health Questionnaire (GHQ-28), and bulimia subescale, the Eating Disorder Inventary (EDI). For the statistical analysis using the statistical program SPSS 15.0. Data are expressed as mean (standard deviation). RESULTS: The weight loss was 3.77 (4.85) kilograms, equivalent to a 3.8 (4.86)% of the total weight, the diameter of the waist was reduced by 3.78 (5.89) centimeters, systolic blood pressure was reduced by 3.36 (15.61) mmHg and diastolic in 2.15 (11.26) mmHg. We also found a decreased significantly of glucose levels 7.37(21.23) mg/dl, insulin levels 2.773 (8.749) IU/ml, HOMA-IR index 0.925 (2.728), triglycerides 12.59 (82.95) mg/dl and uric acid 0.172 (1.13) mg/dl. The basal score of the GHQ-28 was pathological in 44,8% of the studied patients, and after six months of treatment, it improved in 20,8% of the patients (p < 0,001). The EDI bulimia subscale score at the beginning of the treatment was 1,02 (SD 1,91), improving after six months of treatment to 0,65 (SD 1,49) p < 0,002. CONCLUSION: The decrease in weight improves not only clinical parameters and biochemical cardiovascular risk and insulin resistance, but also improves the scale score Goldberg, with higher impact on those with worse baseline GHQ-28 scores.

Taurine and glucose metabolism: a review.

INTRODUCTION: Taurine has probed to be involved in a wide range of biological processes and to provide several different important health benefits. Its effects have been revealed to be exerted mainly through its antioxidant and anti-inflammatory effects, among other mechanisms. OBJECTIVES AND METHODS: The present review is aimed to provide a solid body of evidence regarding the beneficial effects of taurine in the context of diabetes and its complications, with an special focus on the cardiovascular health impairments so frequently associated to this disease, so that data from this updated systematic review of the literature, may constitute a base to back up future clinical and epidemiological studies, on the possibilities of taurine supplementation as a useful tool for both prevention and treatment of diabetes complications. CONCLUSIONS: We consider results from the different experimental, in vitro studies as well as some clinical ones reviewed, to provide sufficient evidence as to constitute a solid base to back up future clinical and epidemiological studies on the usefulness of taurine supplementation both in the prevention and treatment of diabetes and its complications.

[Importance of artificial nutrition in the resolution and etiologic diagnosis of severe chronic diarrhea: a propos of a case]. / Importancia de la nutrición artificial en la resolución y diagnóstico etiológico de diarrea crónica severa: a propósito de un caso.

We present a case of severe chronic diarrhea requiring parenteral nutritional support to both cover the nutritional needs and allow for intestinal rest for later adaptation to enteral nutrition, altogether allowing for the etiologic diagnosis and disease healing.

Plasma mineral content in type-2 diabetic patients and their association with the metabolic syndrome.

BACKGROUND: Metabolic syndrome is a clinical disorder that is becoming more prevalent in Spain. The syndrome encompasses a set of metabolic disorders such as type-2 diabetes mellitus, hypertension, dyslipidemia, and obesity, which may be associated with variations in serum levels and poor delivery of certain mineral elements. METHODS: This study attempted to ascertain whether metabolic syndrome might be linked to alterations in serum levels of the mineral elements magnesium, copper, zinc, chromium, and nickel in a population of 92 diabetic subjects, some suffering from certain conditions associated with the metabolic syndrome, and 72 control subjects (Hospital Príncipe de Asturias, Alcalá de Henares, Spain). RESULTS: The results indicated that as a group the alterations implicated in metabolic syndrome were indeed associated with variations in blood levels of the mineral elements considered, though statistically significant differences were recorded only in the case of copper. Still, trends in mineral levels for each of the separate components contributing to the syndrome tended to increase. CONCLUSION: Metabolic complications appear to be associated with alterations in the levels of some minerals, especially copper.

[Prevalence and consumption of medication in diabetes mellitus in Madrid (1996-2002)]. / Prevalencia y consumo de medicación antidiabética en la Comunidad de Madrid (1996-2002).

OBJECTIVES/AIMS: To determine the prevalence of diabetes mellitus treated with drugs and the prescription of drugs in diabetes (oral anti-diabetics and insulin) in the Community of Madrid between 1996-2002. METHODS: We used the indirect method for estimating the rate of prevalence of diabetes based on antidiabetic drug in the Madrid Community. We studied the consumption or oral antidiabetics (OH) and insulin (IN) in all the Madrid Community Area from 1996 to 2002. To make consumption uniform we used the daily doses/1,000 inhabitants/day (DHD). The total consumption was obtained using the official billing data and the annual population data provided by the "Institute Madrileño de Salud". RESULTS: The prevalence of diabetes mellitus increased 62.5% in the period studied, ranging from 1.6% in 1996 up to 2.6% in 2002. The DHD of oral drugs increased 87.8% from 12.2 in 1996 to 23.07 in 2002. The DHD of insulin decreased 28.2% from 3.99 in 1996 down to 3.11 in 2002. The OH/IN ratio increased 138%, from 3.11 to 7.42 in 2002. There is a tendency to increase biguanide and sulfonilureas with low risk of hypoglycemia. The total cost of insulin and oral medication increase every year, the increase of diabetic patients and the cost/DDD of the new drugs are factors that increase the total cost of diabetes. CONCLUSIONS: The prevalence of diabetes mellitus treated with drugs increased in the Community of Madrid. There is a progressive use of oral drugs versus insulin, and a tendency to prescribe biguanide, sulfonylureas, especially gliclazide and glimepiride. A tendency to substitute insulin with insulin analogues is also seen in the use of insulin. The cost of diabetes increases yearly.

Prevalencia y consumo de medicación antidiabética en la Comunidad de Madrid (1996-2002) / Prevalence and consumption of medication in diabetes mellitus in Madrid (1996-2002)

Objetivo. Determinar la evolución de la prevalencia de diabéticos tratados con fármacos, así como de la prescripción de antidiabéticos (antidiabéticos orales [ADO] e insulina) en la Comunidad de Madrid durante los años 1996-2002. Métodos. Para conocer la prevalencia de diabetes en la Comunidad de Madrid y ver su evolución hemos utilizado el método indirecto del consumo de fármacos (antidiabéticos). Estudiamos el consumo de ADO e insulina en todas las áreas de la Comunidad de Madrid desde 1996 hasta 2002. Con el fin de poder comparar con otros estudios elegimos la unidad estandarizada de medida de dosis diaria definida (DDD), así como la DDD/1.000 habitantes/ día (DHD). El consumo de fármacos fue facilitado por el Instituto Madrileño de Salud y los datos de población se obtuvieron de la tarjeta sanitaria individual (TSI) de cada área de la Comunidad. Resultados. La prevalencia de diabetes se incrementó en el período estudiado un 62,5%, del 1,6% en 1996 al 2,6% en 2002. La prescripción de ADO aumentó un 87,8%, del 12,2 DHD en 1996 a 23,07 en 2002. El consumo de insulina disminuyó un 28,2%, del 3,99 DHD en 1996 a 3,11 en 2002. El índice ADO/insulina se elevó un 138%, del 3,11 al 7,42 en 2002. Existe una modificación de prescripción tanto de ADO, mayor prescripción de biguanidas, así como de sulfonilureas de menor riesgo de hipoglucemia, como de insulinas, con una menor prescripción de insulina de acción intermedia y rápida por análogos de insulina. El coste total tanto de ADO como de insulina se incrementa anualmente por aumento de la población y la elevación de los coste/DDD de los nuevos fármacos. Conclusiones. La Comunidad de Madrid tiene una prevalencia baja de diabetes, existe una tendencia a la prescripción de ADO, destacando el uso de biguanidas y sulfonilureas, especialmente gliclazida y glimepiride. En el uso de insulina se evidencia una tendencia a sustituir las insulinas por análogos de insulina. El coste de la diabetes se incrementa anualmente

Objectives/aims. To determine the prevalence of diabetes mellitus treated with drugs and the prescription of drugs in diabetes (oral anti-diabetics and insulin) in the Community of Madrid between 1996-2002. Methods. We used the indirect method for estimating the rate of prevalence of diabetes based on antidiabetic drug in the Madrid Community. We studied the consumption or oral antidiabetics (OH) and insulin (IN) in all the Madrid Community Area from 1996 to 2002. To make consumption uniform we used the daily doses/1,000 inhabitants/ day (DHD). The total consumption was obtained using the official billing data and the annual population data provided by the «Institute Madrileño de Salud». Results. The prevalence of diabetes mellitus increased 62.5% in the period studied, ranging from 1.6% in 1996 up to 2.6% in 2002. The DHD of oral drugs increased 87.8% from 12.2 in 1996 to 23.07 in 2002. The DHD of insulin decreased 28.2% from 3.99 in 1996 down to 3.11 in 2002. The OH/IN ratio increased 138%, from 3.11 to 7.42 in 2002. There is a tendency to increase biguanide and sulfonilureas with low risk of hypoglycemia. The total cost of insulin and oral medication increase every year, the increase of diabetic patients and the cost/DDD of the new drugs are factors that increase the total cost of diabetes. Conclusions. The prevalence of diabetes mellitus treated with drugs increased in the Community of Madrid. There is a progressive use of oral drugs versus insulin, and a tendency to prescribe biguanide, sulfonylureas, especially gliclazide and glimepiride. A tendency to substitute insulin with insulin analogues is also seen in the use of insulin. The cost of diabetes increases yearly

Prescripción de antidiabéticos orales y uso racional de glibenclamida: Posibilidades de mejora / No disponible

Objetivo: Conocer la prescripción de antidiabéticos orales y el uso de la prescricipción especifica de las especialidades farmacologicas de glibenclamida con el fin de mejor nuestra eficiencia. Diseño: Descriptivo, transversal durante años 2001-2002. Emplazamiento: Comunidad de Madrid, área 4. Mediciones: Determinamos las dosis diarias definidas (DDD) y las dosis definidas por 1000 habitantes(DHD)de los antidiabeticos orales a nivel de área durante el periodo 20012002, así como de cada prescripción especifica de las especialidades farmaceuticas de glibenclamida. Calculamos el indice de buena prescripción en los equipos de glibenclamida (Norglicem/Euglucon+Daonil); así como el ahorro potencial de glibenclamida si se realizara con la especialidad de menor coste. Resultados: La prescripción de antidiabeticos orales 2001 versus 2002 aumentó de 22,19 a 24,69 DHD. La glibenclamida continua siendo el antidiabético oral más prescrito con 7,49 DHD, con una tendencia a disminuir su prescripción. La metformina es el segundo antidiabetico más prescrito con un incremento en su prescripción del 44.84. Existe una tendencia a la prescrición de antidiabéticos de reciente comercialización. La prescripción específica de las especialidades farmacéuticas de glibenclamida son las de mayor coste, existiendo una tendencia a la valoración el coste en los equipos. El ahorro potencial de glibenclamida en los equipos de atención primaria, de pres-cribir la especialidad de menor coste sería de 39.395 euros. Conclusión: El aumento de la población mayor, la prescripción de especialidades farmacéuticas de mayor coste y la aparición de nueva medicación, son factores que influyen en el coste del tratamiento oral de la diabetes (AU)

Aims. The objective of the study is determine the use of oral antidiabetic and the prescription of specific glibenclamide in primary health. Design. Across over, observational study during 2001-2002. Localization. Primary health area 4 of Madrid. Measurement. We determinate the DDD, DHD and cost of oral drugs in diabetic patients type 2. The prescription was taken from the data-base of the area We valorized the ratio of good prescription for glibenclamida (Norglicem/Daonil+Euglucon-5), and the possible reduction of the cost on oral antidiabetc drugs in glibenclamide by the equips of primary health care Results. The prescription of oral drugs increase during the period 2001 versus 2002 increase from 22.19 to 24.69 DHD. Glibenclamida was the oral drug more use in 2002 with 7.49 DHD, with a decrease of 0.75% versus 2001. Metformin is the second drug use and increase versus 2001 in 44.84%.There is high increase in the prescription of new drugs. The use of specific glibenclamida were those of more cost. The potential decrease of cost in glibenclamide by primary health is about 39.395 euros. A better prescription by the ratio (Norglicem/Daonil+Euglucom) is possible, only 3 of the 28 group study have level high of 1. Conclusion. The increase of the poblation , the high cost of the prescription drugs and the increase of new drugs are factor that influence in the cost of oral treatment in diabetic patients type 2 (AU)

Síndrome mielodisplásico, diabetes insípida y déficit progresivo del eje hipotálamo-hipofisario / Myelodysplastic syndrome, diabetes insipidus, and develop of hypothalamic dysfunction

No disponible

Evolución del consumo de antidiabéticos orales e insulinas enl a Comunidad de Madrid y el Área 4 de Madrid

Estudio descriptivo con la finalidad de valorar tanto la prescripción actual como conocer en que medida existen cambios en la utilización de los fármacos hipoglucemiantes. Material y métodos: Base de datos sobre el consumo tanto de número de envases como el importe de antidiabéticos orales e insulinas de la Comunidad de Madrid y del Área 4 de Madrid, así como el estudio de las DHD de dicho Área. Los datos fueron obtenidos de la Subdirección General de Atención Primaria, siendo procesados por el Servicio de Farmacia del Área 4 de Madrid. Resultados: el importe de antidiabéticos orales de la Comunidad de Madrid en el 2001 fue de 8.816.017,44 euros (1.466.861.878 ptaas.) y de insulinas 14.868325,9 euros ( 2.473.881.276 Ptas.). El consumo tanto los antidiabéticos orales como de insulina aumentaron en el período analizado 2000-2001. El incremento en el importe de antidiabéticos orales fue en la Comunidad de Madrid de 60.540.513 pesetas, los inhibidores de alfaglucosidasa en 4.718.340 pesetas, las biguanidas 44.687.749 pesetas, los insulino-secretagogos 72.428.145 pesetas y las glitazonas han supuesto en su primer año de comercializaión 12.615.408 pesetas. El incremento de los antidiabéticos orales tanto a nivel de Comunidad como del Área 4 ha sido debida al aumento deglicazida, glimepiride, repaglidina, miglitol y metformina, habiendo una disminución de acarbosa y sulfonilureas de primera generación. Respecto al incremento en el importe de insulinas destaca sobre todo la precripción y por tanto el importe de la insulina lispro. Conclusiones: las biguanidas hoy día es un fármaco de uso extendido. Existe una tendencia a la prescripción de nuevos fármacos que desplazan los ya existenten, así como un uso de especializadas más caras. Es necesaria la creación de Unidades de diabetes, mejorando la gestión clínica y calidad global de los pacientes diabéticos. (AU)

Fístulas y colitis ulcerosa: a propósito de un caso / Fistulas and ulcerative colitis: a case report

No disponible

[Body mass index influence in the insulin action mechanisms]. / Influencia del índice de masa corporal sobre los mecanismos de acción de la insulina.

OBJECTIVE: Improve the knowledge of the "in vitro" insulin action in healthy subjects with different body mass index (BMI), in order to know the role of obesity in the diabetes mellitus. MATERIAL: In 12 healthy subjects with different BMI and normal oral glucose test we made a gluteal biopsy to obtain adipose tissue. In the isolated adipocytes we studied the interaction of insulin with its receptor and the glucose transport. RESULTS: BMI was not correlated with the maximal specific 125I-insulin binding but was negative when correlated with the glucose transport in basal situation (r = -0.63, p < 0.05) as well as when stimulated with insulin (r = -0.67, p < 0.05), when the results were expressed as number of cells. When the data were expressed as surface, BMI was negative correlated with the percentage of maximal specific 125I-insulin binding (r = -0.81, p < 0.05), and also with the basal glucose transport (r = -0.69, p < 0.05) and stimulated with insulin (r = -0.77, p < 0.01). CONCLUSION: The increase of BMI is an important diabetogenic agent, acting at receptor as well as at postreceptor level, and the data should be expressed according to the cellular diameter rather than to the number of cells in subjects with different BMI. A cutting point was established at the 30 BMI level after which the described alterations could be observed.

Sulphonylurea stimulates glucose uptake in rats through an ATP-sensitive K+ channel dependent mechanism.

We studied the effect of gliclazide, a second-generation sulphonylurea, on rat skeletal muscle glucose uptake using perfused hindquarter muscle preparations. Gliclazide at concentrations of 10 to 1000 microgram/ml increased (p < 0.05) the basal glucose uptake. The effect of gliclazide on glucose uptake was immediate and dose-dependent, reaching a plateau at a concentration of 300 micrograms/ml; the half-maximal effect was obtained between 25 and 50 micrograms/ml. The glucose uptake stimulated by gliclazide (300-1000 micrograms/ml) did not differ from that achieved by 10(-9) mol/l insulin, and was lower (p < 0.05) than that obtained with 10(-7) mol/l insulin. The combination of gliclazide (300 micrograms/ml) and 10(-9) mol/l insulin produced an increase in glucose uptake (7.7 +/- 0.6 mumol.g-1.h-1, n = 8, mean +/- SEM) which was higher (p < 0.05) than that achieved with 10(-9) mol/l insulin (5.6 +/- 0.7 mumol.g-1.h-1, n = 11) and not different from that obtained with 10(-7) mol/l insulin (9.8 +/- 1.0 mumol.g-1.h-1, n = 11). Diazoxide (100 mumol/l), an ATP-sensitive K+ channel opener, reversed the stimulatory effect of gliclazide (100 microgram/ml) on muscle glucose uptake from 3.1 +/- 0.4 to 0.5 +/- 0.2 mumol.g-1.h-1, (n = 7, p < 0.001). The addition of diazoxide prior to gliclazide into the perfusion medium blocked the gliclazide-induced glucose uptake by the hindquarter muscle preparations. In conclusion, gliclazide alone has an immediate stimulatory effect on glucose uptake by skeletal muscle and together with insulin has an additive effect on muscle glucose uptake. The effect of gliclazide on muscle glucose uptake seems to be due to the inhibition of ATP-sensitive K+ channels.

Impaired tyrosine-kinase activity of muscle insulin receptors from hypomagnesaemic rats.

The effect of magnesium deficiency on glucose disposal, glucose-stimulated insulin secretion and insulin action on skeletal muscle was investigated in rats which were fed a low magnesium-containing diet for 4 days. Control rats were fed a standard diet. Compared to the control rats, the rats fed with low magnesium diet presented: 1) lower serum magnesium levels (0.45 +/- 0.02 vs 0.78 +/- 0.01 mmol/l, p < 0.001), 2) higher basal serum glucose (6.8 +/- 0.02 vs 5.5 +/- 0.2 mmol/l, p < 0.05) and similar basal serum insulin, 3) 40% reduction (p < 0.001) in the glucose disappearance rate after its i.v. administration, and 4) 45% reduction (p < 0.05) in the glucose-stimulated insulin secretion. The insulin action upon the glucose uptake by skeletal muscle was determined by means of hindquarter perfusions. Compared with control rats, magnesium-deficient rats presented: 1) normal basal glucose uptake, 2) lower stimulatory effect on the glucose uptake by insulin at the concentrations of 5 x 10(-10) mol/l (3.0 +/- 0.9 vs 5.4 +/- 0.6, p < 0.05) and 5 x 10(-9) mol/l (6.3 +/- 0.5 vs 8.0 +/- 0.5, p < 0.05), 3) normal glucose uptake at a maximal insulin concentration of 1 x 10(-7) mol/l, and 4) 50% reduction in the insulin sensitivity (ED50: 1.3 +/- 0.3 vs 0.55 +/- 0.1 mol/l, p < 0.05). In partially purified insulin receptors prepared from gastrocnemius muscle, 125I-insulin binding was similar in both groups of rats. However, the autophosphorylation of the beta-subunit of the insulin receptor was significantly reduced by 50% in magnesium-deficient rats and the tyrosine kinase activity of insulin receptors toward the exogenous substrate Poly Glu4; Tyr 1 was also reduced (p < 0.05) by hypomagnesaemia. The abundance of the insulin-sensitive glucose transporter protein (muscle/fat GLUT4), measured by Western blot analysis using polyclonal antisera, was similar in muscles of control and hypomagnesaemic rats. These findings indicate that hypomagnesaemia has a deleterious effect on glucose metabolism due to an impairment of both insulin secretion and action. The insulin resistance observed in skeletal muscle of magnesium-deficient rats may be attributed, at least in part, to a defective tyrosine kinase activity of insulin receptors.

Serum and urinary manganese levels in patients with Parkinson's disease.

To elucidate the possible role of manganese in the risk of developing Parkinson's disease (PD), we compared serum levels of manganese, and 24-h manganese excretion by urine in 29 PD patients and in 27 matched controls. We also measured chromium and cobalt in the same samples. All these values did not differ significantly between the groups, they were not influenced by antiparkinsonian drugs, and they did not correlate with age, age at onset and duration of the PD, scores of the Unified PD Rating Scale or the Hoehn & Yahr staging in the PD group. These results might suggest that serum levels and urinary excretion of manganese are apparently unrelated to the risk of developing PD.