Effects of concurrent canine Cushing's syndrome and diabetes Mellitus on insulin requirements, trilostane dose, and survival time.

Trilostane and insulin requirements and survival time of dogs with concurrent naturally-occurring Cushing's syndrome (CS) and diabetes mellitus (DM) has not been fully investigated. This retrospective study evaluated trilostane and insulin doses in dogs with concurrent CS and DM compared to dogs with only CS or DM. Additionally, a survival analysis was performed using a Kaplan-Meier survival curve. Survival time was compared through Log-rank test. Cox proportional regression method was used to screen predictor factors of death in dogs with CS, DM or concurrent CS and DM. A total of 95 dogs were included, 47 dogs had CS, 31 dogs had DM and 17 dogs had concurrent CS and DM. After long-term follow-up, dogs with concurrent CS and DM required higher final median doses of insulin than dogs with DM [0.90 (0.73-1.1) vs 0.67 (0.55-0.73) u/kg/12 h; P = 0,002]. Conversely, the median trilostane requirements in dogs with concurrent CS and DM did not differ from the median trilostane requirements of dogs with CS [1.52 (0.76-2.80) vs 1.64 (1.19-4.95) mg/kg/day; P = 0.283]. No statistical difference was found for the median survival time between dogs with CS and dogs with concurrent CS and DM (1245 vs 892 days; p = 0.152). Although, median survival time of dogs with DM was not reached, it was longer than median survival time of dogs with CS and DM (892 days; P = 0.002). In conclusion, diabetic dogs with concurrent CS need higher insulin doses and have a shorter survival time compared to diabetic dogs without CS.

Kidney function and glucose metabolism in overweight and obese cats.

Background: In people, obesity and prediabetes mellitus might predispose to chronic kidney disease (CKD).Aims: To assess the association of overweight [Body condition score (BCS) >5] and glucose metabolism alterations, with established or potential markers of CKD. In addition, fructosamine and fasted blood glucose were compared as predictors of early abnormal glucose metabolism.Methods: 54 clinically healthy cats were included in a cross-sectional study comprising 25 neutered males and 29 (28 neutered) females aged 7.2 (5.5-9.4) years. Two potential markers of CKD, namely urinary free active transforming growth factor-ß1-creatinine ratio and urinary retinol binding protein-creatinine ratio were measured along with other parameters to assess CKD. A receiver operating curve was used to identify the best sensitivity and specificity of fructosamine to identify cats with fasting glucose >6.5 mmol/L.Results: No association was found between BCS and markers of CKD. Fructosamine was greater in cats with fasting glucose >6.5 mmol/L compared to those with fasting glucose ≤6.5 mmol/L. A fructosamine concentration ≥250 µmol/L was able to detect cats with hyperglycemia with a sensitivity of 77% and a specificity of 65%. Furthermore, fructosamine was more strongly correlated with fasting glucose than albumin-corrected fructosamine (r = 0.43, p = 0.002 vs r = 0.32, p = 0.026). Cats with higher fructosamine had lower serum symmetric dimethylarginine concentrations.Conclusion: The present study does not suggest an effect of obesity on renal function in domestic cats.Clinical relevance: Fructosamine might be of value for the diagnosis of prediabetes mellitus in cats.

Update Review and Clinical Presentation in Congenital Insensitivity to Pain and Anhidrosis.

Introduction. Congenital insensitivity to pain and anhidrosis (CIPA) or hereditary sensory and autonomic neuropathy type IV is an extremely rare syndrome. Three clinical findings define the syndrome: insensitivity to pain, impossibility to sweat, and mental retardation. This pathology is caused by a genetic mutation in the NTRK1 gene, which encodes a tyrosine receptor (TrkA) for nerve growth factor (NGF). Methods. The consultation of a child female in our center with CIPA and a tibia fracture in pseudoarthrosis encouraged us to carefully review literature and examine the therapeutic possibilities. A thorough review of literature published in Pubmed was done about CIPA and other connected medical issues mentioned in the paper. Conclusions. The therapeutic approach of CIPA remains unclear. The preventive approach remains the only possible treatment of CIPA. We propose two new important concepts in the therapeutic approach for these patients: (1) early surgical treatment for long bone fractures to prevent pseudoarthrosis and to allow early weight bearing, decreasing the risk of further osteopenia, and (2) bisphosphonates to avoid the progression of osteopenia and to reduce the number of consecutive fractures.

[Patellar osteochondral injury as onset of patellar instability]. / Lesión osteocondral patelar como debut de una inestabilidad rotuliana.

Patellar osteochondral fractures with no dislocation are uncommon and usually affect the centromedial facet of the patella. We present the case of a 10 year-old, overweight, female patient. She was seen in the emergency room after suffering an accidental fall, assessed as an osteochondral fracture-dislocation of the right patella with upper-outer displaced free fragments. By patient interview, she referred to no previous episodes of patellar dislocation. To complete the study, we performed an MRI which showed a medial facet patellar fracture, with two osteochondral fragments located in the sub-quadricipital recess, associated with other lesions suggesting patellar subluxation. We considered that the best treatment was surgery, so the following was performed: an open reduction and internal fixation with absorbable bars, lateral patellar release (Ficat technique), patellar coverage by medial portion of quadriceps (Insall technique) and internal moving of the lateral half of the patellar tendon (Goldwaith technique). The injury was checked one year later using arthroscopy. It confirmed a good reconstruction of the articular surface, and right patellar centering. At follow-up, during the physiotherapy period, the patient began to have repeated episodes of instability in the contralateral patella. The CT scan confirmed the patellar lateralisation (TAGT 17). Centering surgery was indicated due to the occurrence of multiple dislocation episodes. The patient currently carries out normal physical activity and she has a complete range of movement. Patellar osteochondral fracture is an injury frequently associated with patellar instability, which may onset in the first episode. The medial location of the lesions and the involvement of the system of medial knee stability is a fundamental finding. This fact reinforces the diagnosis of pre-fracture patellar dislocation. This is not a fracture-dislocation, but a dislocation-fracture. We may, therefore, treat the injury and its cause.

[Ménière's disease and migraine]. / Enfermedad de Ménière y migraña.

INTRODUCTION: The possible link between vertigo and migraine has been known for a long time as well as its association with Ménière's disease. OBJECTIVE: To determine the lifetime prevalence of migraine in EM patients and to compare it with the prevalence of migraine in general population according to the International Headache Society (IHS) criteria. METHODS: We interviewed 65 EM patients. Our results have been compared with a sex- and age-matched control group with no otological antecedent. RESULTS: The lifetime prevalence of migraine was significantly higher in Ménière group compared to the age- and sex-matched control group (35.4% versus 15.4%, p < or = 0.05). Nine patients with EM and migraine related an evident relationship between their vertigo episodes and the migraine. CONCLUSIONS: The results obtained in our study suggest the possibility of common pathophysiological mechanisms to both pathologies and it may lead to new therapeutic options for treatment of EM and migraine patients.

Enfermedad de Ménière y migraña / Ménière’s disease and migraine

Introducción: La posible relación del vértigo con la cefalea es conocida desde hace tiempo, al igual que su asociación más concretamente con la Enfermedad de Ménière (EM). Objetivo: Determinar la prevalencia de migraña en pacientes con EM y compararla con la de la población general siguiendo los criterios de la International Headache Society (IHS). Material y métodos: Realizamos una encuesta personal a 65 pacientes con EM. Los resultados han sido comparados con un grupo control formado por 65 personas seleccionadas por edad y sexo y sin patología auditiva previa. Resultados: La prevalencia de migraña en los pacientes con EM resultó ser significativamente superior a la del grupo control (35,4% frente 15,4%, p<=0,05). Nueve pacientes con EM y migraña refieren una relación directa entre los episodios de migraña y los de vértigo. Conclusiones: Los resultados obtenidos nos orientan hacia un posible origen común de estas dos entidades en algunos casos y a plantear alternativas terapéuticas ante pacientes con EM que no mejoran con el tratamiento habitual

Introduction: The possible link between vertigo and migraine has been known for a long time as well as its association with Ménière’s disease. Objective: To determine the lifetime prevalence of migraine in EM patients and to compare it with the prevalence of migraine in general population according to the International Headache Society (IHS) criteria. Methods: We interviewed 65 EM patients. Our results have been compared with a sex- and age-matched control group with no otological antecedent. Results: The lifetime prevalence of migraine was significantly higher in Ménière group compared to the age- and sex-matched control group ( 35,4% versus 15,4% ,p <= 0,05). Nine patients with EM and migraine related an evident relationship between their vertigo episodes and the migraine. Conclusions: The results obtained in our study suggest the possibility of common pathophysiological mechanisms to both pathologies and it may lead to new therapeutic options for treatment of EM and migraine patients

[Kinetic tests representativity in vestibular function]. / Representatividad de las pruebas cinéticas en la función vestibular.

INTRODUCTION: The most frecuently tests used to study the vestibular system, with videonystagmographic register, are the caloric and rotatory ones. MATERIAL AND METHODS: We have carried out a comparative study of the kinetic tests through a sample of 41 patients without vestibular pathology, stratified by age and gender. The performed rotational tests have been: Constant/cycles, postrrotatory test, increasing, decreasing and constant test. RESULTS: We have not observed age or gender influence on the results. We give the numeric results of these tests. CONCLUSION: The obtained data allow to conclude that the information given by the increasing and decreasing pendulous test is similar, phenomenon that doesn't happen in the rest of the practiced tests. We also study the habituation phenomenon to a know stimuli. We point out the importance of each laboratory to have their tests done previously in a normal control group in order to compare the results when performing them in pathological patients.

Representatividad de las pruebas cinéticas en la función vestibular / Kinetics tests representativity in vestibular function

Introducción: Los test con registro videonistagmográfico más utilizados para el estudio del sistema vestibular son las pruebas calóricas y las cinéticas o rotatorias. Material y Métodos: Hemos efectuado un estudio comparativo de las pruebas cinéticas a través de una muestra de 41 pacientes sin patología vestibular, estratificados por edad y sexo. Las pruebas rotatorias practicadas han sido: constante/ciclos, postrrotatoria, creciente, decreciente y constante. Resultados: No hemos observado influencia de edad o sexo sobre los resultados. Se aportan los resultados numéricos de estas pruebas. Conclusiones: Los datos obtenidos permiten concluir que la información aportada por la prueba pendular creciente y decreciente son similares, fenómeno que no ocurre en el resto de las pruebas. Estudiamos también el fenómeno de habituación a un estímulo mantenido. Resaltamos la importancia de que cada laboratorio efectúe sus test a un grupo control normal para utilizarlo como referencia para estudiar a pacientes patológicos

Introduction: The most frecuently tests used to study the vestibular system, with videonystagmographic register, are the caloric and rotatory ones. Material and Methods: We have carried out a comparative study of the kinetic tests through a sample of 41 patients without vestibular pathology, stratified by age and gender. The performed rotational tests have been: Constant/cycles, postrrotatory test, increasing, decreasing and constant test. Results: We have not observed age or gender influence on the results. We give the numeric results of these tests. Conclusion: The obtained data allow to conclude that the information given by the increasing and decreasing pendulous test is similar, phenomenon that doesn't happen in the rest of the practiced tests. We also study the habituation phenomenon to a know stimuli. We point out the importance of each laboratory to have their tests done previously in a normal control group in order to compare the results when performing them in pathological patients