El examen europeo de cirugía vascular: la visión española / The european board of vascular surgery: The spanish vision

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La tomografía por emisión de positrones-tomografía computarizada con 18F-fluordesoxiglucosa en los pacientes con cáncer diferenciado de tiroides en recurrencia y rastreo con radioyodo negativo. Rendimiento diagnóstico y relación con los niveles de tiroglobulina / Positron emission tomography-computed tomography with 18F-fluorodeoxyglucose in patients with recurrent differentiated thyroid carcinoma and negative radioiodine scan. Diagnostic performance and relation with tyroglobulin levels

Objetivo. Evaluar el rendimiento diagnóstico de la PET-TC con 18F-FDG y su relación con los niveles séricos de tiroglobulina (Tg) en los pacientes con cáncer diferenciado de tiroides con sospecha de persistencia o recurrencia de enfermedad y rastreo con radioyodo negativo. Material y métodos. Análisis retrospectivo de 35 estudios PET-TC en 25 pacientes (17 mujeres, edad media 48,8±15,2 años). Los resultados se comprobaron histológicamente, o mediante ecografía y seguimiento clínico. Se analizó la relación entre el rendimiento diagnóstico de la PET-TC y 3 niveles de Tg: ≤2ng/ml; entre 2 y 10 ng/ml, y >10ng/ml. Resultados. Se obtuvieron 26 verdaderos positivos, un falso positivo, 3 verdaderos negativos y 5 falsos negativos. De los 18 pacientes con una PET-TC clasificada como verdadero positivo, 3 mostraron lesiones en el lecho postiroidectomía, 15 mostraron afectación ganglionar y 5 presentaron metástasis a distancia. La sensibilidad fue del 83,9% (IC95%: 69,3-98,4%) y la especificidad del 75% (IC95%: 20-100%). Para 3 intervalos de Tg, la PET-TC mostró una tasa de verdaderos positivos del 37,5, del 83 y del 100% en los pacientes con niveles de Tg <2, entre 2 y 10, y >10 ng/ml, respectivamente. Conclusiones. La PET-TC con 18F-FDG muestra un alto rendimiento diagnóstico de la enfermedad locorregional y a distancia en la población de pacientes con cáncer diferenciado de tiroides en situación de persistencia de enfermedad y rastreo con yodo negativo con niveles de Tg >2ng/ml(AU)

Objective. To assess the diagnostic performance of 18F-FDG PET-CT scan and its relation to serum thyroglobulin (Tg) levels in patients with differentiated thyroid carcinoma with suspicion of persistence or recurrence of the disease and negative radioiodine scans. Materials and methods. This is a retrospective analysis of 35 PET-CT studies in 25 patients (17 women, average age 48.8±15.2 years). The results were confirmed by histology or by ultrasonography and clinical follow-up. We analyzed the relationship between the diagnostic performance of the PET-CT scans and three levels of Tg: ≤2ng/ml; between 2 and 10 ng/ml, and >10ng/ml. Results. We obtained 26 true-positives (TP), one false-positive (FP), 3 true-negatives (TN) and 5 false-negatives (FN). Of the 18 patients with PET-CTs classified as TP, 3 showed lesions at the post-thyroidectomy bed, 15 showed lymph node metastases and 5 were distant metastases. Sensitivity was 83.9% (95%CI: 69.3%-98.4%) and specificity was 75% (95%CI: 20%-100%). Regarding the three intervals of Tg, PET-CT scan showed TP rates of 37.5%, 83% and 100% in patients with Tg levels <2ng/ml, between 2 and 10ng/ml, and >10ng/ml, respectively. Conclusions. 18F-FDG PET-CT demonstrates high diagnostic yield in local disease and distant lesions for the population of patients with differentiated thyroid carcinoma and persistence of the disease with negative radioiodine scans at Tg levels above 2ng/ml(AU)

[Positron emission tomography-computed tomography with (18)F-fluorodeoxyglucose in patients with recurrent differentiated thyroid carcinoma and negative radioiodine scan. Diagnostic performance and relation with tyroglobulin levels]. / La tomografía por emisión de positrones-tomografía computarizada con (18)F-fluordesoxiglucosa en los pacientes con cáncer diferenciado de tiroides en recurrencia y rastreo con radioyodo negativo. Rendimiento diagnóstico y relación con los niveles de tiroglobulina.

OBJECTIVE: To assess the diagnostic performance of (18)F-FDG PET-CT scan and its relation to serum thyroglobulin (Tg) levels in patients with differentiated thyroid carcinoma with suspicion of persistence or recurrence of the disease and negative radioiodine scans. MATERIALS AND METHODS: This is a retrospective analysis of 35 PET-CT studies in 25 patients (17 women, average age 48.8±15.2 years). The results were confirmed by histology or by ultrasonography and clinical follow-up. We analyzed the relationship between the diagnostic performance of the PET-CT scans and three levels of Tg: ≤2ng/ml; between 2 and 10 ng/ml, and >10ng/ml. RESULTS: We obtained 26 true-positives (TP), one false-positive (FP), 3 true-negatives (TN) and 5 false-negatives (FN). Of the 18 patients with PET-CTs classified as TP, 3 showed lesions at the post-thyroidectomy bed, 15 showed lymph node metastases and 5 were distant metastases. Sensitivity was 83.9% (95%CI: 69.3%-98.4%) and specificity was 75% (95%CI: 20%-100%). Regarding the three intervals of Tg, PET-CT scan showed TP rates of 37.5%, 83% and 100% in patients with Tg levels <2ng/ml, between 2 and 10ng/ml, and >10ng/ml, respectively. CONCLUSIONS: (18)F-FDG PET-CT demonstrates high diagnostic yield in local disease and distant lesions for the population of patients with differentiated thyroid carcinoma and persistence of the disease with negative radioiodine scans at Tg levels above 2ng/ml.

Guía de actuación en técnicas y procedimientos endovasculares del sector infrainguinal / Guidelines on infraingual endovascular techniques and procedures

En los últimos años las técnicas de revascularización de los miembros inferiores (MMII) a nivel infrainguinal han cambiado y siguen cambiando a un ritmo considerable, debido al avance de los procedimientos endovasculares, gracias a la aparición de nuevos materiales y de diversos dispositivos, lo que hace que el cirujano vascular se enfrente a todo un arsenal variado que debe conocer, saber sus indicaciones, así como sus bondades e inconvenientes, de la misma forma que debe saber estar al día de los estudios que avalen los resultados de estas técnicas.Es por eso que el Capítulo Endovascular de la Sociedad Española de Angiología y Cirugía Vascular (SEACV) decidió elaborar una guía de los diferentes procedimientos endovasculares para la revascularización y tratamiento de los diferentes sectores del árbol vascular, coordinada por su comité científico. En el presente artículo se desarrolla esta guía, en referencia al sector infrainguinal, realizando una actualización y puesta al día de los diferentes procedimientos, vías de abordaje, técnicas, materiales y dispositivos. El objetivo es ofrecer al cirujano vascular una visión global y actualizada de los distintos procedimientos que se pueden llevar a cabo en los MMII, para poder así ofertar a los pacientes la mejor opción en cada caso y poder lograr la mejor tasa de éxitos posible, apoyados en el concepto de emplear el método de la medicina basada en la evidencia(AU)

In the last few years infrainguinal revascularisation techniques on the lower limbs have changed and continue to change at considerable speed due to advances in endovascular procedures. This is mainly due to the appearance of new and diverse materials and devices, which now means that vascular surgeons are currently faced with a varied armamentarium that they must be familiar with, know their indications, as well as their limits and disadvantages. Likewise, they must keep up to date with studies that support the results of these techniques.It is for these reasons that the Endovascular Chapter of the Spanish Angiology and Vascular Surgery (SEACV) decided to prepare a guide of the different endovascular procedures for the revascularisation and treatment of different sectors of the vascular tree, which was coordinated by its Scientific Committee. The present article describes this guide as regards the infrainguinal sector, reviewing and updating the different procedures, approaches, techniques, material and devices. The aim is to provide the vascular surgeon with an overall and updatedview of the different procedures that can be performed on the lower limbs, in order to offere patients the best option in each case and to achieve the best possible success rate, supported by the concept of using a medical evidence-based method(AU)

A low-energy core-collapse supernova without a hydrogen envelope.

The final fate of massive stars depends on many factors. Theory suggests that some with initial masses greater than 25 to 30 solar masses end up as Wolf-Rayet stars, which are deficient in hydrogen in their outer layers because of mass loss through strong stellar winds. The most massive of these stars have cores which may form a black hole and theory predicts that the resulting explosion of some of them produces ejecta of low kinetic energy, a faint optical luminosity and a small mass fraction of radioactive nickel. An alternative origin for low-energy supernovae is the collapse of the oxygen-neon core of a star of 7-9 solar masses. No weak, hydrogen-deficient, core-collapse supernovae have hitherto been seen. Here we report that SN 2008ha is a faint hydrogen-poor supernova. We propose that other similar events have been observed but have been misclassified as peculiar thermonuclear supernovae (sometimes labelled SN 2002cx-like events). This discovery could link these faint supernovae to some long-duration gamma-ray bursts, because extremely faint, hydrogen-stripped core-collapse supernovae have been proposed to produce such long gamma-ray bursts, the afterglows of which do not show evidence of associated supernovae.

Tratamiento endovascular urgente de una fístula aortobronquial primaria. Presentación de un caso y revisión de la bibliografía / Urgent endovascular treatment of a primary aortobronchial fistula. A case report and review of the literature

Introducción. La fístula aortobronquial es una comunicación patológica entre la aorta torácica y el árbolbronquial, habitualmente del hemitórax izquierdo. Se trata de un cuadro muy poco frecuente en la actualidad, aunque letalen su evolución natural sin tratamiento. La mayoría de éstas se presentan como complicaciones secundarias de la cirugíaclásica sobre la aorta torácica, o de forma secundaria a aneurismas micóticos y pseudoaneurismas aórticos postraumáticos.Caso clínico. El caso descrito destaca por la presencia de un aneurisma sacular fistulizado al árbol bronquializquierdo en una paciente precisamente sin factores de riesgo de arteriosclerosis, antecedentes traumáticos, quirúrgicosni infecciosos. Mediante implante urgente de endoprótesis aórtica torácica conseguimos su sellado con éxito.Aportamos junto a nuestro caso una revisión bibliográfica sistematizando la presentación clínica, el diagnóstico y el tratamientoadecuado. Conclusión. Consideramos esta entidad clínica subsidiaria de tratamiento urgente por su potencialletal latente, mediante implante de endoprótesis aórtica como primera elección frente al tratamiento quirúrgico convencional

Introduction. An aortobronchial fistula is a pathological communication between the thoracic aorta and thebronchial tree, usually the left hemithorax. It is a rare condition today, although its natural history has fatal consequencesif left untreated. Most cases present as complications arising from classical surgery on the thoracic aorta or secondaryto post-traumatic aortic pseudoaneurysms and mycotic aneurysms. Case report. The most striking feature of this case isthe presence of a fistulised saccular aneurysm in the left bronchial tree in a female patient who had no risk factors forarteriosclerosis or any history of traumatic injuries, surgical interventions or infections. It was successfully sealed byurgent placement of a thoracic aortic stent. Our case report is accompanied by a review of the literature that systematisesthe presenting symptoms, the diagnosis and suitable treatment. Conclusions. Owing to its latent fatal potential, weconsider this clinical condition to be amenable to urgent treatment by placement of an aortic stent as the preferredtreatment rather than conventional surgical treatment

Zn mobility and geochemistry in surface sulfide mining soils from SE Spain.

The extraction of metallic minerals and the mineral dressing operations in concentrators produced a high impact in soils and sediments. Heavy metals in soils constitute a high risk of pollution, not only for mining areas, but also for agriculture and villages placed in subsidiary areas. This research has been focused on the assessment of the real environmental and health hazards of Zn in relation to geochemistry and metal mobility in surface soils from a mining area in SE Spain, under semiarid weather conditions. Mineralogy of the studied soils revealed major presence of quartz, but also of other silicates, sulfates, carbonates, and sulfides. Regarding Zn minerals, the presence of sphalerite as the main Zn sulfide, and of goslarite as Zn sulfate, and of smithsonite as Zn carbonate should be highlighted. Soil pH ranged between 4.4 and 4.9 and the electrical conductivity between 55 and 85 microS/cm. By using the sequential extraction procedure, the achieved results show that zinc is not only mainly associated to primary but also to secondary sulfides. Total concentration of the non-available fractions rises up to 98.45% of total Zn in the studied soils. On the other hand, available Zn fraction did not exceed more than 1.55% in percentage and less than 2000 ppm in absolute terms, and when referred to more easily available fraction (water-soluble and exchangeable fractions), these values are not more than 0.44% and then 800 ppm. Therefore, although there is a significant pollution level in this area, immediate hazard for the environment can be assessed as moderate. Finally it should be highlighted that these surface soils have undergone concentration processes of sphalerite, whose mechanisms should be related to the ascending flow of capillary water and the dragging of sphalerite crystals and Zn salts by electrokinetic and colloidal processes These processes seem to occur based on environmental pollution by wind and water erosion, and therefore directly associated to environmental pollution and risks by free metals.

Manejo de la infección protésica inguinal mediante aloinjerto arterial criopreservado, flap muscular rotacional e injerto cutáneo parcial / Management of inguinal graft infections by means of a cryopreserved arterial allograft, rotational muscular flap and partial skin graft

Introducción. La infección protésica inguinal es una complicación grave que pone en riesgo la extremidad revascularizada, y su solución resulta compleja en muchas ocasiones, incluso en las mejores situaciones. Caso clínico. Varón de 56 años con varias cirugías revascularizadoras en ambos miembros inferiores y ausencia de vena autóloga. Presenta antecedente de infección precoz en una prótesis femoropoplítea tratada con retirada parcial. Acude por infección inguinal con bypass femoropoplíteo infragenicular compuesto (politetrafluoroetileno-vena safena interna) permeable. Se realizó un amplio desbridamiento de la zona, con la retirada de la prótesis residual, y se implantó un bypass ortoanatómico con aloinjerto arterial criopreservado y posterior cobertura con flap muscular rotacional (recto anterior-sartorio) e injerto cutáneo parcial. Visto en una revisión a los tres meses con permeabilidad del bypass y buena integración del injerto. Conclusión. En caso de infección protésica, asociada a gran afectación tisular, y ausencia de material autólogo para su sustitución, el empleo de un aloinjerto arterial criopreservado con posterior cobertura con un flap muscular y cutáneo se presenta como una opción válida en su manejo

Introduction. Inguinal graft infections constitute a severe complication that puts the revascularised limb at risk and they are often difficult to resolve, even in the best situations. Case report. A 56-year-old male who had previously undergone several revascularisation operations in both lower limbs and had no autologous veins. The patient had previously suffered early infection of a femoral-popliteal graft which was treated by means of partial withdrawal. He visited because of an inguinal infection with a compound (polytetrafluoroethylene-great saphenous vein) below-theknee femoral-popliteal bypass that was seen to be patent. The procedure consisted in wide debridement of the area, with removal of the residual graft, and an anatomic bypass was implanted with a cryopreserved arterial allograft and later covered with a rotational muscular (rectus femoris-sartorius) flap and partial skin graft. In a control visit at three months, the bypass was seen to be patent and the graft was well integrated. Conclusions. In cases of infection of a prosthetic graft, associated with widespread tissue involvement, and the absence of autologous material with which to replace it, use of a cryopreserved arterial allograft that is later covered with a muscle and skin flap has proved to be a valid management option

Anomalías congénitas del sistema venoso cavo superior. A propósito de dos casos / Congenital anomalies of the superior caval venous system. Two case reports

Introducción. La persistencia de la vena cava superior izquierda (VCSI) es la anomalía venosa torácica más frecuente, con una prevalencia de hasta el 2% en la población general. De curso asintomático, su detección suele corresponder a un hallazgo durante la cateterización de vías venosas centrales superiores. Reconocer alguna de sus variantes ante dificultades durante el cateterismo puede evitarnos iatrogenia o errores diagnósticos. Casos clínicos. Caso 1: mujer de 58 años, con insuficiencia renal terminal en hemodiálisis. Historia de múltiples accesos vasculares. Implantamos un nuevo catéter en la vía yugular izquierda. Técnica habitual sin anomalías. Comprobamos el buen funcionamiento de ambas luces y con radioscopia observamos su extremo en silueta cardíaca, con latido y un recorrido anómalo paravertebral izquierdo. La placa de control reveló un recorrido semejante al de una VCSI. La gasometría era venosa y se practicó angiorresonancia magnética y angiografía para diferenciar una VCSI de posibles malposiciones. El catéter fue útil en tres sesiones antes de su retirada. Caso 2: mujer de 32 años, con síndrome de Down y disfunción sinusal. Programada para implante de marcapasos DDDR (doble ‘sensado’, doble estímulo y doble respuesta). Se avanzaron los cables vía vena cefálica izquierda, dibujándose una silueta de VCSI, desconocida previamente. A través del seno coronario se implantaron en sus respectivos destinos. Chequeo normal. Conclusión. La VCSI y sus variantes congénitas son anomalías venosas no infrecuentes, cuya detección durante el cateterismo de vías centrales superiores es esencial para evitar iatrogenia grave (perforación venosa central) y falsos diagnósticos sobre malposiciones intraarteriales o extravasculares intratorácicas

Introduction. Persistent left superior vena cava (LSVC) is the most frequent thoracic venous anomaly, with a prevalence of up to 2% in the general population. As it is asymptomatic, it is usually only detected during catheterisation of the upper central veins. Recognising some of its variants when faced with difficulties during catheterisation can save us from iatrogenic effects or diagnostic errors. Case reports. Case 1: a 58-year-old female with terminal renal failure on haemodialysis. The patient had a history of multiple vascular accesses. We placed a new catheter in the left jugular line. This is a usual procedure with no anomalies. We checked both lumina were functioning properly and with radioscopy we observed its tip in the cardiac silhouette, with an anomalous left paravertebral route and beating. The control X-ray revealed a route that was similar to that of an LSVC. Blood gas analysis showed it to be venous and magnetic resonance angiography and angiography were performed to distinguish an LSVC from possible malpositioning. The catheter was used in three sessions before it was withdrawn. Case 2: a 32-year-old female with Down syndrome and sinus node dysfunction. The patient was programmed for a DDDR (dual sensor, dual stimulus and dual response) pacemaker implant. The wires were run along the left cephalic vein, which traced a previously unknown LSVC silhouette. They were implanted in their respective destinations through the coronary sinus. Check-up was normal. Conclusions. LSVC and its congenital variants are venous anomalies that are not infrequent; their detection during the catheterisation of upper central lines is essential in order to prevent serious iatrogenic effects (perforation of the central venous line) and false diagnoses involving intra-arterial intrathoracic or extravascular malpositioning

Seguimiento no invasivo de los aneurismas periféricos tratados de forma endovascular / Non-invasive follow-up of peripheral aneurysms treated by endovascular means

Objetivo. Valorar la necesidad del seguimiento de la cirugía endovascular en los aneurismas periféricos y los parámetros que se estudian. Pacientes y métodos. Búsqueda bibliográfica de series publicadas y experiencia en nuestro servicio. Resultados. En las series encontradas se observa una mejoría en los resultados, debida sobre todo al desarrollo técnico y la evolución de los dispositivos empleados. Los parámetros estudiados en las distintas series han sido la permeabilidad, la velocidad del flujo en el interior de la endoprótesis, la detección de flujo en el saco aneurismático y los cambios en el diámetro del saco. Se detectaron alteraciones corregibles y asintomáticas hasta en el 20% de los casos. Conclusiones. El seguimiento con eco-Doppler parece justificado por el número de lesiones asintomáticas que detecta. Los parámetros mínimos que se deberían valorar son la permeabilidad, las posibles aceleraciones del flujo intraprotésicas y la existencia de flujo o endofugas en el saco aneurismático

Aim. To evaluate the need for follow-ups in endovascular surgery in peripheral aneurysms and the parameters that are studied. Patients and methods.We conducted a search in the literature for series that have been reported and our own experience in our service. Results. The series that were found showed an improvement in the outcomes, above all due to technical progress and advances made in the devices that are used. The parameters that were studied in the different series were patency, flow velocity inside the stent, detection of flow inside the aneurysmal sac and changes in the diameter of the sac. Correctable and asymptomatic alterations were found in up to 20% of cases. Conclusions. Follow-up using Doppler ultrasound seems to be justified owing to the number of asymptomatic lesions it detects. The minimum parameters that should be appraised are patency, possible accelerations of intraprosthetic flow and the existence of flow or endoleaks in the aneurysmal sac

Reparación endovascular de la rotura aórtica torácica en traumatismos cerrados. Presentación de dos casos / Endovascular repair of ruptured thoracic aortas in closed traumatic injuries. Two case reports

Objetivo. Presentar nuestra experiencia en el manejo de la rotura traumática de la aorta torácica en los traumatismoscerrados. Introducción. La rotura de la aorta torácica en traumatismos cerrados es una entidad grave, asociadaa una elevada morbimortalidad con el tratamiento quirúrgico convencional. La cirugía endovascular se está imponiendoen el tratamiento de la patología vascular torácica, por lo que, dada su menor agresividad, parece estar aún másindicada en esta patología. Casos clínicos. Caso 1: varón de 34 años que, tras un accidente de motocicleta, presentabaun politraumatismo con múltiples fracturas óseas, lesiones abdominales y craneales. Fue trasladado a nuestro centrocon un diagnóstico de rotura aórtica torácica e intervenido de forma urgente mediante dos endoprótesis. El control a los24 meses se observó la exclusión completa de la lesión sin fugas. Caso 2: varón de 19 años que, tras un accidente de tráfico,presentaba un politraumatismo con múltiples fracturas óseas, lesiones abdominales y craneales. Fue trasladado anuestro centro con un diagnóstico de rotura aórtica e intervenido de forma urgente mediante una endoprótesis. El controla los seis meses se observó la exclusión completa de la lesión sin fugas. Conclusión. La rotura de la aorta torácica entraumatismos cerrados es una entidad de elevada morbimortalidad y la reparación endovascular, a nuestro juicio, constituyeuna opción válida

Aim. To present our experience in the management of traumatic rupture of the thoracic aorta in closed trauma. ;;Introduction. Rupture of the thoracic aorta due to closed traumatic injuries is a severe condition that is associated to ;;high morbidity and mortality rates with conventional surgical treatment. Endovascular surgery is becoming the ;;preferred technique in thoracic vascular pathologies and therefore, due to its being less aggressive, it seems to be even ;;more indicated in this pathology. Case reports. Case 1: a 34-year-old male who, following a motorcycle accident, had ;;multiple traumatic injuries including several fractured bones and abdominal and cranial injuries. He was brought to our ;;centre with a diagnosis of rupture of the thoracic aorta and was submitted to emergency surgical treatment involving the ;;placement of two stent-grafts. The control visit at 24 months revealed complete exclusion of the lesion with no leaks. ;;Case 2: a 19-year-old male who, following an automobile accident, had multiple traumatic injuries including several ;;fractured bones and abdominal and cranial injuries. He was brought to our centre with a diagnosis of rupture of the aorta and was submitted to emergency surgical treatment involving the placement of a stent-graft. The control visit at six ;;months revealed complete exclusion of the lesion with no leaks. Conclusions. Rupture of the thoracic aorta in closed ;;traumatic injuries is a condition with high morbidity and mortality rates and endovascular repair is, in our opinion, a valid therapeutic option

[Comparison of administration of rhTSH with withdrawal of thyroid hormone. Follow-up of patients with differentiated thyroid carcinoma]. / Estudio comparativo entre la utilización de TSH recombinante y la estimulación endógena con TSH. Valoración en el seguimiento de los pacientes con carcinoma diferenciado de tiroides.

UNLABELLED: Recombinant human thyrotropin (rhTSH) has been introduced recently in follow up of differentiated thyroid cancer (DTC) patients, as an alternative of thyroid hormone withdrawal. The aim of this retrospective study is to compare recombinant human thyrotropin versus endogenous stimulation. MATERIAL AND METHODS: Thirty-three patients with DTC with previous thyroidectomy and thyroid ablation were selected. All patients underwent whole-body radioiodine scanning and third day serum thyroglobulin (TG) measurement by two techniques, the first one after conventional thyroid hormone withdrawal (TSHe, TGe), and the second one after rhTSH stimulation (TSHr, TGr). Measurement of TG was performed on the third day due to the infrastructure. We only included patients with stable disease, without therapeutic interventions between two consecutive controls in an interval inferior to one year. Two qualitative categories were defined for TG (positive TG > 2 ng/ml or negative TG<2 ng/ml) and whole-body radioiodine scan (positive or negative). RESULTS: TSHe: 62.9 +/- 55.48; TSHr: 113.16 +/- 50.6; (p: ns); TGe: 62.5 +/- 115.7; TGr: 54.6 +/- 111.1; (p: 0.044). Quantitative data analysis showed significant differences between two techniques. Qualitative data analysis showed no significant differences in clinical setting based in TG and radioiodine scan. CONCLUSIONS: Administration of rhTSH produces a significantly higher increase of TSH than thyroid hormone withdrawal and lower increase in TG levels. There were no significant differences in the stage of disease (TG and whole-body radioiodine scan).

Estudio comparativo entre la utilización de TSH recombinante y la estimulación endógena con TSH. Valoración en el seguimiento de los pacientes con carcinoma diferenciado de tiroides / Comparison of administration of rhTSH with withdrawal of thyroid hormone. Follow-up of patients with differentiated thyroid carcinoma

En el seguimiento habitual de los pacientes con cáncer diferenciado (CDT) se ha introducido recientemente el uso de la hormona tirotropa (TSH) humana recombinante (rhTSH) como alternativa a la retirada del tratamiento supresivo hormonal. El objetivo de este estudio retrospectivo es comparar el resultado de la administración de rhTSH con respecto a la estimulación con TSH endógena en el seguimiento del CDT. Material y métodos. Hemos seleccionado 33 pacientes con CDT a los que se había practicado previamente una tiroidectomía total y la ablación de restos tiroideos con 131I. Todos los pacientes tenían un control previo de rastreo con yodo y tiroglobulina (TG) sérica con suspensión del tratamiento hormonal (TSHe, TGe) y un nuevo control con rhTSH (TSHr, TGr). La determinación de la TG se realizó el tercer día por motivos de infraestructura. Se incluyeron sólo los pacientes sin cambios clínicos ni actuaciones terapéuticas entre los dos controles realizados con un intervalo máximo de un año. Se definieron dos categorías para la TG (positiva si TG > 2 ng/ml y negativa si TG < 2ng/ml) y para el rastreo (positivo o negativo). Resultados. Los valores analíticos obtenidos para cada control fueron los siguientes: TSHe: 62,9 ± 55,48 U/ml; TSHr: 113,16 ± 50,6 U/ml; (p: ns); TGe: 62,5 ± 115,7 mg/ml; TGr: 54,6 ± 111,1 mg/ml; (p: 0,044). La valoración cualitativa de los resultados obtenidos (prueba positiva o negativa) en ambos controles no mostró diferencias significativas ni en el resultado de la TG ni en rastreo con yodo. Conclusiones. El incremento de la TSH con previa administración de rhTSH es significativamente mayor que el incremento mediante estimulación endógena, mientras que las cifras de TG son globalmente menores. No se aprecian diferencias en la valoración de la presencia o ausencia de la enfermedad mediante TG y rastreo con yodo

Recombinant human thyrotropin (rhTSH) has been introduced recently in follow up of differentiated thyroid cancer (DTC) patients, as an alternative of thyroid hormone withdrawal. The aim of this retrospective study is to compare recombinant human thyrotropin versus endogenous stimulation. Material and methods. Thirty-three patients with DTC with previous thyroidectomy and thyroid ablation were selected. All patients underwent whole-body radioiodine scanning and third day serum thyroglobulin (TG) measurement by two techniques, the first one after conventional thyroid hormone withdrawal (TSHe, TGe), and the second one after rhTSH stimulation (TSHr, TGr). Measurement of TG was performed on the third day due to the infrastructure. We only included patients with stable disease, without therapeutic interventions between two consecutive controls in an interval inferior to one year. Two qualitative categories were defined for TG (positive TG > 2ng/ml or negative TG < 2ng/ml) and whole-body radioiodine scan (positive or negative). Results. TSHe: 62.9 ± 55.48; TSHr: 113.16 ± 50.6; (p: ns); TGe: 62.5 ± 115.7; TGr: 54.6 ± 111.1; (p: 0.044). Quantitative data analysis showed significant differences between two techniques. Qualitative data analysis showed no significant differences in clinical setting based in TG and radioiodine scan. Conclusions. Administration of rhTSH produces a significantly higher increase of TSH than thyroid hormone withdrawal and lower increase in TG levels. There were no significant differences in the stage of disease (TG and whole-body radioiodine scan)

[Pathological characteristics of patients with diabetes mellitus type 2, in Spanish Primary Care]. / Perfil de los pacientes con diabetes mellitus tipo 2, en la Atención Primaria española.

CONTEXT: To know the characteristics, related risk factors, and degree of control in patients with diabetes mellitus type 2 (DM2) in our country. METHODS: Observational, unrandom, opened, and multicenter study. Anthropometric characteristics, substance abuse, medication, control of diabetes, cholesterol, and triglycerides were analyzed in 5,395 patients. The patients were classified according to the length of the diagnosis: recent diabetes (RD) and known diabetes (KD). The chi-square test was utilized in order to compare the categorical variables, and the Student's t test for compare the continuous variables. The relationship between these variables was analyzed through the Pearson's correlation coefficient, and an analysis of multiple correspondence was carried out. RESULTS: Median age, 63 years; obese, 34%; smokers, 11%; drinkers, 24%; hypertensives, 44%; lipemic, 42%. Control degree: HbA1c>6.5% in 79%, LDLc>115 mg/dl in 80%. Hypoglycemic treatment: sulfonylureas, 62.8%; antidiabetics combination, 5%; only insulin, 4.3%; insulin combined with antidiabetics, 20.6%. Control of diabetics, of lipids, and of weight was lower in the patients with KD that in the patients with RD (HbA1c, 7.6% versus 7%; LDLc 148 mg/dl versus 136 mg/dl; percentage of obese, 27.2% versus 38.62%). A relationship between the length of evolution of diabetes and the deterioration of the control of blood glucose and of lipids was detected. CONCLUSION: DM2 and its associated risk factors are insufficiently controlled in our country. The drug combination and insulin are utilized scarcely.

Perfil de los pacientes con diabetes mellitus tipo 2, en la Atención Primaria española / Pathological characteristics of patients with diabetes mellitus tipe 2, in Spanish Primary Care

Fundamento. Conocer las características, factores de riesgo asociados y el grado de control de los pacientes con diabetes mellitus tipo 2 (DM2) de nuestro país. Métodos. Estudio observacional, no aleatorizado, abierto y multicéntrico. Se analizó en 5.395 pacientes sus características antropométricas, hábitos tóxicos, medicación, control de la diabetes, colesterol y triglicéridos. Se dividieron según la antigüedad del diagnóstico en diabetes reciente (DR) y diabetes conocida (DC). Se utilizó la prueba de 2 para comparar las variables categóricas y la "t" de Student para comparar las variables continuas. La relación entre estas variables se analizó mediante el coeficiente de correlación de Pearson y se realizó un análisis de correspondencias múltiples. Resultados. Edad media, 63 años; obesos, 34 por ciento; fumadores, 11 por ciento; bebedores, 24 por ciento; hipertensos, 44 por ciento; hiperlipidémicos, 42 por ciento. Grado de control: HbA1c > 6,5 por ciento en el 79 por ciento, c-LDL>115 mg/dl en el 80 por ciento. Tratamiento hipoglucemiante: sulfonilurea, 62,8 por ciento; combinación de antidiabéticos, 5 por ciento; insulina sola 4,3 por ciento, y combinada con antidiabéticos, 20,6 por ciento. El control de la diabetes, de los lípidos y del peso fue peor en los pacientes con DC que en los DR (HbA1c, 7,6 por ciento frente al 7 por ciento; LDL, 148 mg/dl frente a 136 mg/dl; porcentaje de obesos, 27,2 por ciento frente al 38,62 por ciento). Encontramos relación entre el tiempo de evolución de la diabetes y el deterioro del control de la glucemia y de los lípidos. Conclusión. La DM2 y los factores de riesgo asociados están mal controlados en nuestro país. Se utiliza poco la combinación de fármacos y la insulina (AU)

[Acromegaly and Graves-Basedow disease. Report of 3 cases]. / Acromegalia y enfermedad de Graves-Basedow. A propósito de 3 casos.

Acromegaly is associated to thyroidal disorders such as hyperthyroidism. The Graves-Basedow disease as a cause of thyroid hyperfunction is very infrequent, with only 8 cases having been reported up to 1993. The authors present 3 patients with acromegaly who developed hyperthyroidism due to Graves-Basedow disease in the course of their disease. Two of the patients had acromegaly of 30 years of evolution and the third patient underwent consultation for clinical symptoms of hyperthyroidism with acromegaly being simultaneously diagnosed. All the patients had weight loss prior to diagnosis and the possibility of neoplasia associated to acromegaly was excluded. The hyperthyroidism responded well to initial treatment with antithyroid drugs in the three cases. The authors conclude that hyperthyroidism should be taken into consideration in the diagnosis of a patient with acromegaly and weight loss.

[Glycemic control and lipoprotein profile in type I diabetes mellitus]. / Control glucémico y perfil lipoproteico en la diabetes mellitus tipo I.

BACKGROUND: To analyze the relation between the degree of glycemic control and the lipoprotein profile in type I diabetes mellitus. METHODS: Seventy-five diabetics were studied in whom the total glycohemoglobin (GHb), total triglycerides (TG), triglycerides of very low density lipoproteins (TG-VLDL), total cholesterol (TC), cholesterol of very low density lipoproteins (C-VLDL), cholesterol of high density lipoproteins (c-HDL), apolipoprotein AI (Apo AI) and apolipoprotein B (Apo B) were determined. Patients were classified according to their GHb: less than 9% (good glycemic control), 9-11% (moderate glycemic control) and greater than 11% (bad glycemic control). There was homogeneity in the 3 groups with regards to other variables which influenced the lipoprotein profile. RESULTS: The concentrations of TG, TG-VLDL, TC, C-VLDL and C-LDL were significantly higher in the groups of greater GHb while those of C-HDL, Apo I and Apo B were independent of the degree of glycemic control. The number of patients whose lipid profiles may be considered as atherogenic risk increases progressively in groups with greater GHb. CONCLUSIONS: In patients with type I diabetes mellitus, bad glycemic control is accompanied by decreases in TG, TC and C-LDL up to a magnitude which frequently reaches risk values for developing vascular disease. However, in these subjects, a less protector effect dependent on C-HDL is not to be expected since their concentrations are similar to those patients with good glycemic control.