Diabetes insípida como primera manifestación de metástasis hipofisaria / Insipid diabetes as first sign of pituitary metastasis

Introducción: Diabetes insipidus as the first clinical manifestation of pituitary neoplasm metastasis Up to de 90 percent of the masses that are detected in the pituitary gland correspond to adenomas. On the contrary, pituitary metastasis only represent a 1 percent, which is a diagnostic challenge in the medical practice. Most of the time, these lesions are detected casually in autopsy; but it is important to consider that aproximatelly a 7 percent of these lesions can be clinically expresed as diabetes insipidus. Here we present a patient with initial symptoms of diabetes insipidus with the final diagnostic of lung adenocarcinoma

Methylation cycle, arginine-creatine pathway and asymmetric dimethylarginine in paediatric renal transplant.

BACKGROUND: Hyperhomocysteinaemia represents an important cause of morbidity in recipients of renal transplants, but few investigations have been carried out to evaluate the status of the methylation cycle and its relation with levels of new cardiovascular biomarkers, such as asymmetric dimethylarginine (ADMA). METHODS: Twenty-six children and adolescents aged 7-18 years (17 male, 9 female) with stable renal transplants were recruited for the study. None had received treatment with folate, vitamin B(12) or statins. Levels of ADMA in plasma and of components of the methylation cycle and arginine (Arg)-creatine pathway in plasma and urine were analysed by specific analytical methods. Results were compared to those obtained by us with identical methods in healthy children of similar age. RESULTS: Concentrations of homocysteine (Hcys), S-adenosylhomocysteine (SAH) and ADMA were significantly higher, while S-adenosylmethionine (SAM)/SAH and Arg/ADMA ratios were significantly lower than controls. Arg/ADMA ratio correlated with plasma guanidinoacetate. The components of the methylation cycle, Hcys and SAH correlated with renal function. CONCLUSIONS: Children with renal transplant showed low methylation power (SAM/SAH) mainly due to increased levels of SAH which acts as a cardiovascular biomarker. Elevated values of ADMA and low Arg/ADMA coefficients also represent a novel finding because it inhibits nitric oxide synthesis contributing to endothelial dysfunction and cardiovascular risk in such patients.

La comunicación en oncología pediátrica desde el punto de vista del cirujano / The communication in paediatric oncology from the surgeon´s point of view

La comunicación forma parte del acto médico y va más allá de la mera transmisión de datos técnicos y pronósticos terapéutico. Conforma la relación médico-paciente y se extiende hacia el entorno familiar del enfermo. En este sentido, diremos que tiene una faceta terapéutica individual y social. Del modo de informar dependerán hechos tan importantes como la relación con el paciente, con su familia y allegado y su colaboración en el tratamiento. Desde otro punto de vista, la falta de información es la principal queja de los pacientes y sus familias y una de las concausas de denuncia por malpraxis más habituales. El proceso comunicativo en Medicina no sería más difícil que en cualquier otra área pero la implicación emocional del receptor de la información, paciente o familiar, lo convierte en algo totalmente diferente. Para el cirujano infantil que trabaja en Oncología Pediátrica, la comunicación tiene todas estas características y algunas más. Se enfrenta al tópico de que los niños no se mueren de cáncer, segunda causa de muerte infantil en los países desarrollados; el principal receptor de la información no suele ser el paciente sino sus padres y por último, la información al paciente que siempre debe ser “a la medida” tiene aquí un factor nuevo y capital: la edad. Aportamos nuestra experiencia estructurada sobre la cronología del proceso, desde el primer contacto hasta el alta quirúrgica del paciente. Palabras claves: Comunicación, Oncología pediátrica. Cirugía (AU)

Communication is part of the medical performance. It does not only imply to inform the patient about the treatment, but also to have a relationship with the cancer patient and his family. Moreover, it has a social and individual therapeutic aspect. The relationship with the patient´s family and the patient himself, as well as their adhesion to the treatment, will depend on how we inform them. In fact, the lack of information is the main complain and one of the most frequent causes of legal action taken of malpractice. The process of communication in Medicine is difficult due the emotional implication of the receiver of the information. Besides, for the paediatric surgeon working in Oncology, communication is even more problematic, because he has to face the belief that children do not die of cancer- though it is the second cause of paediatric death in the developed countries. The first to be informed is seldom the patient, but his parents. Furthermore, the information given to the patient must be according to his age. In this work we contribute our experience in communication since the first contact until the patient is discharged from hospital(AU)

Fatty acid composition of skeletal muscle and adipose tissue in Spanish infants and children.

There is a relationship between the fatty acid profile in skeletal muscle phospholipids and peripheral resistance to insulin in adults, but similar data have not been reported in infancy and childhood. The objective of this study was to investigate the fatty acid composition of skeletal muscle and adipose tissue across the paediatric age range. The fatty acid profile of skeletal muscle phospholipids and adipose tissue triacylglycerols was analysed in ninety-three healthy Spanish infants and children distributed into four groups: group 1 (0 to <2 years, n 10); group 2 (2 to <5 years, n 41); group 3 (5 to <10 years, n 24); group 4 (10 to 15 years, n 18). In skeletal muscle phospholipids, oleic acid (18: 1n-9cis) content decreased significantly whereas that of linoleic (18: 2n-6) acid increased significantly with age (P for trend <0.01). In adipose tissue, the contents of triacylglycerol and linoleic acid increased significantly across the paediatric age range (P for trend <0.01), whereas dihomo-gamma-linolenic (20: 3n-6) and arachidonic (20: 4n-6) showed significant differences between groups. The variations in fatty acid composition observed with age indicated an imbalance in dietary n-3/n-6 long-chain PUFA.