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Objetivos. Conocer el estado del control glucémico de los pacientes ancianos con diabetes mellitus tipo 2 en España y su relación con la capacidad funcional y la comorbilidad. Métodos. Estudio transversal, observacional, multicéntrico, de ámbito nacional, en pacientes con diabetes mellitus≥65 años. Se estudiaron variables sociodemográficas, antropométricas, factores de riesgo cardiovascular, datos de exploración clínica y analíticos, comorbilidad asociada y tratamientos utilizados. Se analizó la capacidad funcional mediante el índice de Barthel y la comorbilidad con el de Charlson. Resultados. Se incluyeron 939 pacientes. La edad media fue 76,4±6,7 años. La hemoglobina glucosilada (HbA1c) media fue 7,0±1,2% y la glucemia basal media 137±39,6mg/dl. El nivel de HbA1c presentó diferencias estadísticamente significativas según el grado de discapacidad. En los pacientes con dependencia total, grave, moderada, leve o independientes las concentraciones de HbA1c media fueron de 7,0%, 7,9%, 7,4% y 7,0% (p<0,028) respectivamente. Los niveles de HbA1c fueron de 7,3%, 7,1% y 6,9% en los pacientes con comorbilidad muy alta, alta y media, respectivamente (p<0,001). Conclusiones. Los valores medios de HbA1c en los pacientes ancianos con diabetes tipo 2 analizados en España son inferiores a los recomendados por las principales guías de práctica clínica. Son más elevados en los pacientes que presentan mayor grado de discapacidad funcional y un nivel más alto de comorbilidad (AU)
Objectives. To understand the state of glycaemic control of elderly patients with type 2 diabetes mellitus in Spain and its relationship with functional capacity and comorbidity. Methods. Cross-sectional, observational, multicentre national study on patients with diabetes mellitus aged 65 years or older. The study analysed demographic and anthropometric variables, cardiovascular risk factors, clinical and laboratory data, associated comorbidity and treatments. We analysed the functional capacity using the Barthel index and the comorbidity with Charlson index. Results. The study included 939 patients with a mean age of 76.4±6.7 years. The mean glycated haemoglobin (HbA1c) level was 7.0%±1.2%, and the mean basal blood glucose level was 137±39.6mg/dL. The HbA1c level showed statistically significant differences depending on the degree of disability. In the patients who were totally, severely, moderately or slightly dependent or who were independent, the mean HbA1c levels were 7.0%, 7.9%, 7.4% and 7.0%, respectively (P<.028). HbA1c levels were 7.3%, 7.1% and 6.9% in the patients with very high, high and medium comorbidity, respectively (P<.001). Conclusions. Mean HbA1c levels in elderly patients with type 2 diabetes analysed in Spain are below those recommended by the main clinical practice guidelines. The levels are higher in patients who have more functional disability and a higher level of comorbidity (AU)
Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Hyperglycemia/prevention & control , Glycated Hemoglobin/analysis , Diabetes Mellitus, Type 2/physiopathology , Cross-Sectional Studies , Glycemic Index , Comorbidity , Risk Factors , Hypoglycemia/epidemiology , Frail Elderly/statistics & numerical data , Hypoglycemic Agents/therapeutic use , Anticholesteremic Agents/therapeutic use , Antihypertensive Agents/therapeutic useABSTRACT
OBJECTIVES: To understand the state of glycaemic control of elderly patients with type 2 diabetes mellitus in Spain and its relationship with functional capacity and comorbidity. METHODS: Cross-sectional, observational, multicentre national study on patients with diabetes mellitus aged 65 years or older. The study analysed demographic and anthropometric variables, cardiovascular risk factors, clinical and laboratory data, associated comorbidity and treatments. We analysed the functional capacity using the Barthel index and the comorbidity with Charlson index. RESULTS: The study included 939 patients with a mean age of 76.4±6.7 years. The mean glycated haemoglobin (HbA1c) level was 7.0%±1.2%, and the mean basal blood glucose level was 137±39.6mg/dL. The HbA1c level showed statistically significant differences depending on the degree of disability. In the patients who were totally, severely, moderately or slightly dependent or who were independent, the mean HbA1c levels were 7.0%, 7.9%, 7.4% and 7.0%, respectively (P<.028). HbA1c levels were 7.3%, 7.1% and 6.9% in the patients with very high, high and medium comorbidity, respectively (P<.001). CONCLUSIONS: Mean HbA1c levels in elderly patients with type 2 diabetes analysed in Spain are below those recommended by the main clinical practice guidelines. The levels are higher in patients who have more functional disability and a higher level of comorbidity.
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Subject(s)
Humans , Glucose Metabolism Disorders/epidemiology , Prevalence , Carbohydrates/metabolism , Glucose Metabolism Disorders/diagnosis , Glucose Metabolism Disorders/metabolismABSTRACT
OBJECTIVE: To determine the prevalence of impaired fasting glucose (IFG or GBA), impaired glucose tolerance (IGT) and type 2 diabetes mellitus (DM2) in the adult population of Yecla. RESEARCH, DESIGN, AND METHODS: We performed a population-based cross-sectional study (on Primary Care Field) with stratified and random sampling (393) from 17 500 residents in Yecla with sanitary card and aged > or =30 years. We studied 286 subjects (107 declining to participate) and 261 of them (125 men and 136 women) underwent an oral glucose tolerance test (OGTT). MAIN MEASUREMENTS: World Health Organization (WHO-99) and American Diabetes Association (ADA-97) criteria were used for diagnosis of unknown DM2, GBA and IGT. Socio-demographic and anthropometric variables were measured. Plasma lipid, glycosylated haemoglobin (HbA1C), microalbuminuria and insulin levels also were measured. Insulin resistance was evaluated by the HOMA method. RESULTS: According ADA-97 criteria the prevalence of DM2 and GBA was 2.65 (CI+/-1.95) and 4.3% (+/-2.5) respectively. Underwent an OGTT, the age-adjusted prevalence of DM2, IGT and GBA (using the Spanish population of July 02) was 6.7 (95%CI, 3,7-9,7); 13.2 (95%CI, 9.1-17.3) and 0.2% (95%CI, 0-1.8) respectively. The known DM2 was 5,9% (95%CI, 3.8-8) and the global prevalence of DM2 was 12.6% (95%CI, 9.6-15.6). The diabetes was associated with overweight, overage and higher insulin, HbA1C and insulin resistance levels. CONCLUSIONS: There is a high prevalence of DM2 in Yecla (known/unknown 0.87/1). The ADA97 criteria only detected 53% of the unknown DM2. The 78% of normoglycemics subjects had overweight or upper-body fat distribution and diabetics people had higher BMI (Body Mass Index), Hypertension, insulinemia, HbA1C and insulin resistance levels than normoglycemics and IGT subjects.
Subject(s)
Carbohydrate Metabolism , Diabetes Mellitus, Type 2/epidemiology , Glucose Intolerance/epidemiology , Adult , Age Distribution , Aged , Blood Glucose/analysis , Cross-Sectional Studies , Diabetes Mellitus, Type 2/diagnosis , Female , Glucose Intolerance/diagnosis , Glucose Tolerance Test , Humans , Male , Middle Aged , Prevalence , Sex Distribution , Spain/epidemiologyABSTRACT
Myophosphorylase deficiency, or McArdle disease, is an uncommon entity. The gene for human myophosphorylase has been cloned and is located on chromosome 11, in keeping with the autosomal recessive nature of the disease and there is an excess of male patients. The diagnosis is established by documentation of elevated glycogen content and reduced phosphorylase activity in biopsied muscle tissue. We report four cases with McArdle disease which were 16, 15, 11 and 5 years old. They were brothers, and they came to the hospital because of pain, cramps and myoglobinuria after exercise or infection; in the first case, a male patient, myoglobinuria caused acute renal failure. Three of them showed reduced phosphorylase activity in biopsied muscle tissue. We discuss the different therapeutic possibilities.
Subject(s)
Glycogen Storage Disease Type V/diagnosis , Glycogen Storage Disease Type V/genetics , Adolescent , Child , Glycogen Storage Disease Type V/enzymology , Humans , Male , Phosphorylases/deficiencyABSTRACT
La deficiencia de miofosforilasa o enfermedad de McArdle es una entidad rara. El gen para la enzima miofosforilasa ha sido clonado y localizado en el cromosoma 11. La enfermedad se hereda de forma autosómica recesiva con un predominio en los varones. El diagnóstico se establece por la elevación en el contenido de glucógeno y la reducción de la actividad de la enzima en la biopsia de tejido muscular. Presentamos cuatro hermanos de 16,15,11 y 5 años con enfermedad de Mc Ardle. Consultaron por dolor, calambres y mioglobinuria tras ejercicio o infección, en uno de los casos, la mioglobinuria causó un fallo renal agudo. Tres de los casos demostraron una reducción de la actividad de la fosforilasa en la biopsia muscular. Nosotros comentamos los aspectos diagnósticos y también las diferentes posibilidades terapéuticas. (AU)
Subject(s)
Child , Adolescent , Male , Humans , Phosphorylases , Glycogen Storage Disease Type VABSTRACT
A historical, prospective, multicenter, observational study was conducted on data from October 1996 to December 1997 to determine the impact of hemoglobin (Hb) variability on the interpretation of maintenance anemia management outcomes in hemodialysis patients. Trends in mean Hb levels were retrospectively analyzed to determine whether there were any differences between 1-month Hb averages versus 3- or 6-month rolling averages. Results showed that: (a) Hb measurements exhibit wide variability between patients and within patients, regardless of the assessment method used, and (b) it is difficult to maintain patients within the 1 g/dL Hb spread recommended by NKF-K/DOQI. The largest variations in Hb readings were observed in 1-month readings, while 6-month rolling averages exhibited the least variability. These data illustrate the importance of assessing long-term trends in laboratory data before making incremental or decremental modifications in the anemia prescription.
Subject(s)
Anemia, Iron-Deficiency/blood , Data Interpretation, Statistical , Hemoglobinometry/standards , Hemoglobins/analysis , Kidney Failure, Chronic/complications , Renal Dialysis/adverse effects , Anemia, Iron-Deficiency/drug therapy , Anemia, Iron-Deficiency/etiology , Bias , Guideline Adherence , Hemoglobinometry/methods , Humans , Patient Selection , Practice Guidelines as Topic , Practice Patterns, Physicians'/standards , Predictive Value of Tests , Prospective Studies , Retrospective Studies , Total Quality ManagementABSTRACT
We present a case of ureteropelvic junction (UPJ) obstruction which had the unusual presentation of early satiety and weight loss secondary to gastric compression by a distended renal pelvis. The patient was treated successfully with percutaneous antegrade endopyelotomy.
Subject(s)
Satiety Response , Ureteral Obstruction/pathology , Ureteral Obstruction/physiopathology , Weight Loss , Female , Humans , Hydronephrosis/diagnostic imaging , Hydronephrosis/etiology , Hydronephrosis/surgery , Kidney Pelvis/diagnostic imaging , Middle Aged , Stomach/diagnostic imaging , Tomography, X-Ray Computed , Ureteral Obstruction/complications , Ureteral Obstruction/surgeryABSTRACT
Chlorambucil derivatives involving alkyl 2-aminodeoxy sugars have been synthesized in good yield by coupling the chlorambucil moiety to positions C-2 or C-3 of the sugar, directly or via a spacer. The starting material was easily available from 2-acetamido-2-deoxy-D-glucose. The final compounds were tested for cytotoxicity, and some of those that presented the best results were studied for inhibition of cell proliferation.
Subject(s)
Amino Sugars/administration & dosage , Antineoplastic Agents, Alkylating/administration & dosage , Chlorambucil/administration & dosage , Deoxy Sugars/administration & dosage , Adult , Amino Sugars/chemistry , Amino Sugars/toxicity , Animals , Antineoplastic Agents, Alkylating/chemistry , Antineoplastic Agents, Alkylating/toxicity , Carcinoma/pathology , Cell Division/drug effects , Chlorambucil/chemistry , Chlorambucil/toxicity , Deoxy Sugars/chemistry , Deoxy Sugars/toxicity , Drug Carriers , Ethanolamine/chemistry , Female , Humans , Leukemia, Promyelocytic, Acute/pathology , Mice , Molecular Structure , Nasopharyngeal Neoplasms/pathology , Tumor Cells, Cultured/drug effectsABSTRACT
OBJECTIVES: to determine IL-1alpha and IL-1beta levels in patients with bacterial cystitis, microscopic hematuria, and gravid females relative to a control group of normal subjects. METHODS: enzyme immunoassays were used to measure concomitantly urinary IL-1alpha and IL-1beta in clean catch urine samples from normal subjects (n = 31) and study patients (n = 46). All normal subjects and patients underwent urinalysis, urine culture, and urine creatinine level determination. Since the IL-1alpha assay was developed for serum, the utility of the assay for urine specimens was unknown. The key parameters of urine collection, processing and sample storage for IL-1alpha were evaluated in detail. RESULTS: mean values +/- SEM (pg/mg) for IL-1alpha/ Cr and IL-1beta/Cr were control group (0.25 +/- 0.10 and 0.17 +/- 0.06), bacterial cystitis (9.97 +/- 1.15 and 42.45 +/- 1.86), and microscopic hematuria (2.81 +/- 0.65 and 2.82 +/- 0.70). Differences in cytokine levels between the control group and patients with either bacterial cystitis or microscopic hematuria were statistically significant for both IL-1alpha/Cr (P < 0.026; P < 0.007, respectively) and IL-1beta /Cr (P < 0.0004; P < 0.014, respectively). IL-1beta/Cr correlates better with pyuria than IL-1alpha/ Cr (P = 0.02 vs P = 0.44). In gravid females, only IL-1alpha was significantly elevated relative to non-pregnant females (IL-1beta elevation approached statistical significance). Gravid females with positive urine cultures could not be distinguished from those with negative cultures based on either interleukin (P > 0.05). CONCLUSIONS: Significant elevations of IL-1alpha and IL-1beta occur in patients with bacterial cystitis and microscopic hematuria. Correlation between pyuria and cytokine elevation was stronger for IL-1beta than for IL-1alpha. Changes in IL-1alpha may reflect changes in the bladder epithelium rather than in the inflammatory leukocytes. The ability of IL-1alpha and IL-1beta to serve as markers for bacterial cystitis in gravid females is diminished due to high basal levels during pregnancy.
Subject(s)
Bacterial Infections/immunology , Cystitis/immunology , Hematuria/immunology , Interleukin-1/urine , Pregnancy/immunology , Bacterial Infections/urine , Case-Control Studies , Cystitis/urine , Female , Hematuria/urine , Humans , Immunoenzyme Techniques/statistics & numerical data , Pregnancy/urine , Pyuria/immunology , Pyuria/urine , Reproducibility of Results , Sensitivity and SpecificityABSTRACT
PURPOSE: We challenge the requirement for routine placement of a nephrostomy tube following percutaneous renal surgery. MATERIALS AND METHODS: A total of 50 patients underwent tubeless percutaneous renal procedures consisting of nephrolithotripsy, endopyelotomy, and stone extraction plus endopyelotomy performed during the same setting. In the initial 30 patients a Double-J* stent and a Councill nephrostomy tube were placed at the end of the procedure. The Councill catheter was removed 2 to 3 hours postoperatively. The subsequent 20 patients received only a Double-J stent with no Councill catheter. This study group was compared to a control group of 50 age, sex and procedure matched patients who had previously undergone standard percutaneous renal procedures with routine placement of postoperative nephrostomy tubes. The incidence of complications, analgesia requirements, length of hospitalization, interval to return to normal activities and cost of treatment were compared between the 2 groups. RESULTS: All 50 tubeless percutaneous procedures were performed successfully without significant complications. In the initial 15 patients postoperative renal ultrasound demonstrated no urinoma. Hospitalization was 0.6 days for the study group and 4.6 days for the controls (p = 0.0001). Average parenteral or intramuscular analgesia requirements were 11.58 and 36.06 mg. morphine sulfate, respectively (p = 0.0001), with patients requiring oral analgesia for 5.9 and 11.7 days, respectively (p = 0.0001). Patients in the study group returned to normal activities within 17.85 days versus 26.6 days for the controls (p = 0.0004). The costs of the procedures were $1,638 and $3,750 (129% greater), respectively, for a cost saving of $2,112 per case. CONCLUSIONS: Tubeless percutaneous renal surgery is a safe procedure and offers numerous advantages over routine placement of a nephrostomy tube. The hospitalization, analgesia requirements, return to normal activities as well as cost are significantly less with this new technique.
Subject(s)
Kidney/surgery , Nephrostomy, Percutaneous , Female , Humans , Male , Middle Aged , Stents , Urinary CatheterizationABSTRACT
We describe our modification of the technique of traditional percutaneous renal surgery called "tubeless" percutaneous renal surgery. Fifty patients have now undergone percutaneous renal procedures without the use of a postoperative nephrostomy tube consisting of percutaneous nephrolithotripsy, percutaneous endopyelotomy, and both percutaneous stone extraction and endopyelotomy in the same setting. Our current modification of standard percutaneous surgical technique includes the placement of an internal ureteral catheter with primary closure of the access site using hemostatic skin sutures. The study group was compared to a control group of 50 patients who were age, sex and procedure matched who had undergone standard percutaneous renal procedures previously with routine placement of postoperative nephrostomy tubes. The incidence of complications, analgesia requirements, length of hospitalization, time of return to normal activities, and cost of treatment were compared between the two groups. All tubeless percutaneous procedures were successfully performed without significant complications. The initial 15 patients had postoperative renal ultrasounds demonstrating no urinoma. Hospital stay, analgesia requirements, and the patient's ability to return to normal activities were statistically significantly decreased in the patient group studied. The cost of a "tubeless" procedure was $1,638 compared with $3,750 (129% greater) for traditional percutaneous surgery (cost saving of $2,112/case). Tubeless percutaneous renal surgery is a safe procedure and offers advantages over the routine placement of a nephrostomy tube. The hospitalization period, analgesia requirements, return to normal activities, and cost are significantly less with this new technique.
Subject(s)
Kidney Calculi/surgery , Nephrostomy, Percutaneous/methods , Activities of Daily Living , Analgesics/therapeutic use , Case-Control Studies , Cost Savings , Dermatologic Surgical Procedures , Female , Health Care Costs , Hemostasis, Surgical , Hospitalization , Humans , Incidence , Kidney Calculi/therapy , Kidney Pelvis/surgery , Length of Stay , Lithotripsy/adverse effects , Lithotripsy/economics , Lithotripsy/instrumentation , Lithotripsy/methods , Male , Nephrostomy, Percutaneous/adverse effects , Nephrostomy, Percutaneous/economics , Nephrostomy, Percutaneous/instrumentation , Pain, Postoperative/drug therapy , Suture Techniques , Treatment Outcome , Ureter , Urinary Catheterization/adverse effects , Urinary Catheterization/economics , Urinary Catheterization/instrumentationABSTRACT
We prospectively analyzed three types of ureteral stents to determine the effects of diameter and composition on a patient's symptoms. Twenty stents were placed consecutively in each of the three study groups for the treatment of ureteral obstruction, prior to SWL, or following ureteroscopy: Group I = 6F Percuflex stent, Group II = 6F HydroPlus stent, and Group III = 4.8F HydroPlus stent. All stents were removed in clinic 7 to 10 days after placement. At this time, a confidential questionnaire was completed by the patient addressing the symptoms associated with the indwelling catheter. The 6F hydrogel-coated stents were somewhat easier to insert, especially in high-grade obstructions. Occasional difficulty in seeing the 4.8F stent during fluoroscopy was noted. No statistically significant difference in any of the irritative voiding symptoms-dysuria (P = 0.7998), urgency (P = 0.0928), frequency (P = 0.2646), nocturia (P = 0.2855), hematuria (P = 0.9417), pain (P = 0.4524), or incontinence (P = 0.4524)-was demonstrated. Differences in stent diameter and composition do not appear to affect symptoms. We prefer the hydrogel-coated 6F stent, as it offers advantages in ease of placement and radiographic visibility without increased symptoms.
Subject(s)
Stents , Ureteral Obstruction/surgery , Adult , Catheters, Indwelling , Female , Fluoroscopy , Humans , Hydrogel, Polyethylene Glycol Dimethacrylate , Lithotripsy , Male , Middle Aged , Polyethylene Glycols , Postoperative Complications , Prospective Studies , Surveys and Questionnaires , Ureteral Obstruction/diagnostic imaging , Ureteral Obstruction/physiopathology , UreteroscopyABSTRACT
Patient satisfaction with the three-piece inflatable penile prosthesis was evaluated in two surgical subgroups following randomized implantation: those who underwent implantation via an infrapubic (IP) approach and those via a penoscrotal (PS) incision. Follow-up questionnaires were mailed to 86 patients who had undergone implantation of a Mentor alpha-1 or AMS 700CX inflatable penile prosthesis between August 1989 and November 1992. The questionnaire (54 items) was designed to elicit both factual and perceptual information in the areas of general medical information, prosthesis usage, erectile quality, postoperative complications, and general satisfaction. Questionnaire data was enhanced by a review of the clinic and hospital records of each patient who returned the questionnaire. Patients were followed postoperatively at regular intervals for a minimum of 6 months. Results demonstrate an overall patient satisfaction of 85%. Breakdown into the two surgical subgroups revealed similar rates of satisfaction by both groups. Analysis of the 42 questionnaires returned demonstrated no statistical differences in the replies of the two groups in either the factual or perceptual data. The most common sources of dissatisfaction related to penile length, girth, and difficulty with usage. This study demonstrates no compelling advantages in employing one surgical approach over the other.
Subject(s)
Penile Prosthesis , Humans , Male , Middle Aged , Patient Satisfaction , Penis/surgery , Prosthesis Design , Scrotum/surgeryABSTRACT
A case of successful treatment of glans hyperemia following a modified VIRAG II deep penile vein revascularization is reported. Potency was preserved using an open surgical technique to ligate an arterialized communicating venous segment.
Subject(s)
Erectile Dysfunction/prevention & control , Hyperemia/surgery , Penis/surgery , Angiography , Erectile Dysfunction/etiology , Humans , Hyperemia/diagnostic imaging , Male , Middle Aged , Penis/blood supply , Penis/diagnostic imaging , Postoperative Complications/prevention & control , Regional Blood Flow/physiology , Vascular Surgical Procedures , Veins/surgeryABSTRACT
In this study, we examine with attention the latest etiopathogenic findings of this protein-like group of diseases in which even today, exist unclear and controversial aspects. We analyze from an immunological point of view either the role of immunocomplexes and the role of cell-mediated immunity, standing out the direct antibodies-mediated injury, especially emphasizing antineutrophil antibodies. Next, we describe steps and attitudes to be taken when facing one of these diseases diagnosis, including not only suspect, confirmation and degree of spreading, but also setting behaviour guidelines that make feasible the search of associate diseases and discarding other kind of diseases with which may arise some confusion.
Subject(s)
Vasculitis/etiology , Antibodies/immunology , Humans , Immune Complex Diseases/complications , Immune Complex Diseases/immunology , Immunity, Cellular/immunology , Vasculitis/diagnosis , Vasculitis/immunologyABSTRACT
The development of a malignant tumor, as well as hypertrichosis lanuginosa as a paraneoplasic syndrome, in a patient afflicted with scleroderma is a very rare event. We present the clinical history of a patient afflicted with scleroderma, non-differentiated bronchopulmonary carcinoma adn hypertrichosis lanuginosa as paraneoplasic expression of the tumor.
Subject(s)
Bronchial Neoplasms/diagnosis , Carcinoma/diagnosis , Hypertrichosis/diagnosis , Lung Neoplasms/diagnosis , Paraneoplastic Syndromes/diagnosis , Scleroderma, Systemic/diagnosis , Biopsy , Bronchial Neoplasms/pathology , Carcinoma/pathology , Humans , Hypertrichosis/pathology , Lung Neoplasms/pathology , Male , Middle Aged , Paraneoplastic Syndromes/pathology , Scleroderma, Systemic/pathology , Skin/pathologyABSTRACT
An 8-center European clinical trial has established that pirmenol in dosages up to 400 mg daily is effective and safe for treating stable, high frequency, ventricular ectopy. At dosages of 300 mg and 400 mg of pirmenol a day, the average frequency of ectopy/hour decreased markedly compared with baseline values. The percentage of responders (premature ventricular contraction suppression of 70% compared with baseline) among the patients receiving 300 mg or 400 mg of pirmenol/day was significantly higher than in the placebo group. Observation of the frequency of reported adverse experiences, clinical laboratory tests and electrocardiographic tracings shows that dosages of pirmenol up to 400 mg daily were well tolerated.
