Nuclear Medicine Methods for Evaluation of Abnormal Parathyroid Glands in Patients with Primary and Secondary Hyperparathyroidism.

Considered rare disease in the past, primary hyperparathyroidism (PHPT) has dramatically increased in incidence over the past thirty years with the introduction of routine calcium measurements; it is now approximately 42 per 100 000 persons. By far, the most common lesion found in patients with PHPT is the solitary parathyroid adenoma, occurring in 85%-90% of patients, while in the rest 10%- 15% primary hyperplasia of the parathyroid glands is present. Currently, the most widely used surgical approach is minimally invasive parathyroidectomy which is associated with less post-surgery complications and shorter operation time. To be successful this procedure needs to rely on a precise preoperative localization of the abnormal parathyroid glands, hence preoperative parathyroid imaging gained so large importance. The rationale for locating abnormal parathyroid tissue prior to surgery is that the glands can be notoriously unpredictable in their location. There is a general consensus that the best imaging procedure identifying abnormal parathyroid glands is the preoperative scintigraphy with 99mTc-sestamibi or 99mTc-tetrofosmin. It is characterized with high sensitivity and specificity exceeding those of ultrasound, CT or MRI. Combining scintigraphy with the other imaging techniques increases the precision for topic localization.

Bone mineral density and fracture risk in patients with type 1 and type 2 diabetes mellitus.

UNLABELLED: Diabetes affects an estimated 6-8% of the population worldwide. This widespread disorder is often associated with changes in bone health which are still little studied. To date, there has been no generally accepted definition of diabetic osteopathy. The changes in the bone mineral density, the bone turnover markers and frequency and type of fractures that occur in the two major clinical types of diabetes (type 1 and type 2) differ because they are associated with different pathogenetic mechanisms inducing these disorders. While it is reduction of the bone mineral density that most often occurs in type 1 diabetes, in type 2 diabetes various studies diagnose either a normal, reduced or increased bone mineral density in comparison with that of healthy controls. Both vertebral and non-vertebral fractures are found to have increased incidence in both types of diabetes which is attributed to, in addition to the changes in the mineral density of bones, a number of concomitant factors such as visual impairment, diabetic neuropathy, etc. There are studies demonstrating that women with type 1 diabetes are at a significantly higher risk of hip fractures (relative risk [RR]: 8.9 [95% confidence interval (CI): 1.2-64.4]) and for those with type 2 diabetes: (RR: 2.0 [95% CI: 1.12-1.35]). The mortality rate in the first year after a patient sustains a fracture of the neck of the femur in men is about 36%, and in women--about 21%. The changes in the bone mineral density in diabetes are caused by a number of disorders--negative calcium balance, hypoinsulinemia, deteriorated renal function, increased production of advanced glycation end products, low peak bone mass, increased production of inflammatory cytokines, etc. CONCLUSIONS: Although there are differences in the quantitative changes of bone mineral density, patients with diabetes mellitus have a higher risk of sustaining specific types of fractures. It can be partially accounted for by the greater propensity to falling, as well as to the decreased bone toughness caused not only by the quantitative changes but also by the altered bone quality. Diabetics with additional osteoporosis predisposing risk factors or with current fractures should have their bone density measured and then receive a relevant prophylactic treatment.

Amaryl (glimepiride) in patients with type 2 diabetes mellitus.

The purpose of the present study was to investigate the effect of the first third-generation sulphonylurea drug glimepiride (Amaryl, Aventis) in the treatment of patients with type 2 diabetes mellitus in an open 6-month clinical trial. The study included 19 patients with type 2 diabetes mellitus (7 men and 12 women, aged 53.6 +/- 2.43 years, mean duration of diabetes 7.79 +/- 1.45 years). The body mass index (BMI) of the patients was x = 30.157 +/- 1.63 which is at the borderline between overweight and obesity. The patients started at a baseline dosage of 1 mg which was then it was gradually adjusted according to the blood sugar level. The dosage of the drug varied between 1 and 6 mg (mean daily dosage 2.03 mg). The metabolic control parameters that were calculated included fasting and 2-hour postprandial blood sugar concentration, total cholesterol, serum triglycerides, HbA1c, and microproteinuria. They were measured at baseline, at 3 and 6 months. The results showed that the fasting blood glucose decreased significantly (P<0.05 at 3 months and P<0.001 at 6 months). Statistically significant lower postprandial glycemia was also observed in the patients (the decrease was not significant at 3 months but highly significant at 6 months, P<0.01). The overall evaluation was based on the values of HbA1c--they were statistically significantly lower at 6 months (P<0.01) which suggests the steady improving tendency of the metabolic control in type 2 diabetes patients treated with Amaryl (glimepiride). The improvement of the metabolic control was also manifested by the lower serum triglycerides levels (P<0.05) and the BMI remaining nearly without change. It is concluded that Amaryl (glimepiride) is an efficacious oral sulphonylurea preparation which can be used as an appropriate substitute of the other beta cell stimulators. Glimepiride once daily provides a good compliance of patients which reduces to minimum the skipped doses. It is associated with a reduced risk of hypoglycemia and causes no weight gain.