ABSTRACT
The objective of this cross-sectional study was to evaluate the impact of early diabetic nephropathy on the presence of cardiovascular disease (CVD) in a Mediterranean population, as well as the prevalence in these patients of traditional cardiovascular risk factors and its treatment intensity in accordance with international recommendations. In 123 patients with type 2 diabetes and incipient nephropathy the presence of CVD, smoking, hypertension, dyslipemia, and their treatment was recorded. CVD prevalence was 34%. Age, nephropathy stage (micro/macroalbuminuria), and smoking were associated with the presence of CVD. Hypertension, dyslipemia, and smoking were present in 83%, 81%, and 59%, respectively. Coexistence of several risk factors was frequent and was associated with a higher incidence of CVD. 79% hypertensive patients and 43% dyslipemic patients received pharmacological treatment but only 17% and 9%, respectively, reached a good control of their disease. Patients with known CVD showed also a deficient control. Accordingly, early diabetic nephropathy induces a multiplier effect on the cardiovascular risk of a Mediterranean population. Higher prevalence and association with cardiovascular risk factors, with smoking in a predominant role, are associated with this higher risk. Despite this, the intensity of treatment and control of these risk factors is deficient, which means that a better and more intensive treatment should reduce the morbidity and mortality in these patients.
Subject(s)
Cardiovascular Diseases/drug therapy , Cardiovascular Diseases/epidemiology , Diabetic Nephropathies/drug therapy , Diabetic Nephropathies/epidemiology , Aged , Albuminuria/epidemiology , Cardiovascular Diseases/etiology , Cross-Sectional Studies , Diabetes Mellitus, Type 2/epidemiology , Diabetic Nephropathies/etiology , Female , Humans , Male , Mediterranean Region/epidemiology , Middle Aged , Prevalence , Risk FactorsABSTRACT
El objetivo de este estudio transversal fue evaluar el impacto de la nefropatía diabética inicial sobre la presencia de enfermedad cardiovascular (ECV) en una población mediterránea, así como la prevalencia en estos pacientes de factores de riesgo cardiovascular clásicos y su grado de tratamiento de acuerdo con las recomendaciones internacionales. En 123 pacientes con diabetes tipo 2 y nefropatía incipiente se registró la presencia de ECV, tabaquismo, hipertensión arterial, dislipidemia y sus tratamientos. La prevalencia de ECV fue del 34 por ciento. La edad, fase de la nefropatía (micro/macroalbuminuria) y el tabaquismo se asociaron con la presencia de ECV. La hipertensión, dislipidemia y tabaquismo estaban presentes en el 83 por ciento, 81 por ciento y 59 por ciento, respectivamente.La coexistencia de los diferentes factores de riesgo era frecuente y se asoció con una mayor presencia de ECV. El 79 por ciento de los pacientes hipertensos y el 43 por ciento de los dislipidémicos recibían tratamiento farmacológico, pero sólo el 17 por ciento y el 9 por ciento, respectivamente, obtenían un buen control.Los pacientes con ECV ya conocida mostraban igualmente un deficitario grado de control. Por tanto, la nefropatía diabética inicial ejerce un efecto multiplicador del riesgo cardiovascular en una población mediterránea. La alta prevalencia y asociación de factores de riesgo cardiovascular, desempeñando el tabaquismo un papel preponderante, se asocian con este riesgo tan aumentado. A pesar de ello, el grado de tratamiento y control de estos factores de riesgo es deficiente, por lo que un mejor y más intensivo tratamiento debería reducir la morbimortalidad de estos enfermos (AU)
Subject(s)
Aged , Male , Middle Aged , Humans , Female , Mediterranean Region , Cardiovascular Diseases , Cross-Sectional Studies , Prevalence , Diabetic Nephropathies , Albuminuria , Risk Factors , Diabetes Mellitus, Type 2ABSTRACT
OBJECTIVE: We have investigated the prevalence, signification and prognostic value of lymphocytic infiltration associated to differentiated thyroid carcinoma in our series of differentiated carcinoma of the thyroid. METHODS: We studied the presence of lymphocytic infiltration in 223 patients effected of differentiated thyroid carcinoma, 138 of them were papillary carcinoma. The diagnostic was made with optic microscopy and we studied antithyroid antibodies in these patients. In survival analysis we studied all the variables of the patients and the event used as end point was death due to thyroid carcinoma, summarized in Kaplan-Meir curve and Cox method. RESULTS: We found eight patients with differentiated thyroid carcinoma, six with papillary carcinoma, and lymphocytic thyroiditis and in three cases, antithyroid antibodies were present at low levels. We did not found any difference between the two groups and the survival rate was similar. CONCLUSIONS: These data support that in our series the prevalence of lymphocytic infiltration was low and probably without prognostic signification.
Subject(s)
Carcinoma/immunology , Thyroid Neoplasms/immunology , Adult , Carcinoma/mortality , Carcinoma, Papillary/immunology , Carcinoma, Papillary/mortality , Female , Humans , Immunity, Cellular , Lymphocytes/immunology , Male , Prognosis , Thyroid Neoplasms/mortalityABSTRACT
BACKGROUND: The aims of this study are to identify prognostic factors of differentiated thyroid carcinoma and to validate the application of prognostic classifications obtained by others studies to another population. PATIENTS AND METHODS: The survival of 208 patients with differentiated thyroid carcinoma (129 papillary and 79 follicular carcinoma) was calculated by the Kaplan-Meier method. The mean follow-up was 7.5 years (1-17.7). Cox-proportional hazard model was used for variables influencing on survival (Mantel-Cox method). In addition, the EORTC, AGES, AJC, AMES and DeGroot classifications were tested. RESULTS: The independent prognostic factors identified were patient age > 60 years, tumor size > 6 cm and the presence of distant metastases. The absence of poor prognostic factors defined the low risk group (153 patients, survival 97% at 17.7 years of follow-up). The application of the other prognostic classifications differentiated several risk groups not in accordance with those obtained in the initial population. CONCLUSIONS: In this series of patients with thyroid carcinoma the main prognostic factors were age, tumor size and the presence of distant metastases. However, there are pitfalls in applying the prognostic classifications of published studies to another population.
Subject(s)
Adenocarcinoma, Follicular/mortality , Carcinoma, Papillary/mortality , Thyroid Neoplasms/mortality , Adult , Aged , Female , Humans , Male , Middle Aged , Prognosis , Proportional Hazards Models , Survival AnalysisABSTRACT
The period of time between clinical manifestations and admission of 18 patients with pituitary apoplexy (PA) was of a mean of 6 days with the exception of two cases. Distribution by age and sex, absence of previous endocrinal clinical manifestations in 38.8% of the patients was similar to that of larger series described. Headache constituted an almost constant symptom. The most affected cranial pairs were II (12 patients), III and IV, both in 8 cases. Following decompression surgery, great improvement was observed in visual acuteness in 5 of these patients, and in the ophthalmoplexy in 8. Alterations in the level of consciousness is less and less frequent in the context of PA thanks to the diagnosis of less severe clinical episodes. Similarly, a high rate of clinical suspicion and the use of new imaging techniques (NMR) have contributed notably with the most outstanding findings being resumed. Moreover, a case of PA with associated intracranial aneurysm verified by carotid angiography is described.
Subject(s)
Pituitary Apoplexy/diagnosis , Adult , Aged , Female , Follow-Up Studies , Humans , Male , Middle Aged , Pituitary Apoplexy/diagnostic imaging , RadiographyABSTRACT
Sixteen cases of newly diagnosed Addison disease were studied by CT scan. An initial diagnosis was performed according to the clinical data of each patient, and a second diagnosis after examining the abdominal CT scan. According to the second diagnosis there were six patients with primary adrenal failure of probable autoimmune origin, six tuberculosis, two metastatic, one undetermined and one hemorrhagic. The second diagnosis coincided with the first one in 10 cases (62.5%), but was different in six cases (37.5%). Information obtained by CT scan modified the therapeutic attitude in 4 cases (25%). The main morphologic patterns of adrenal glands in CT scan (atrophy, calcification and enlargement) are commented as well as the importance of CT scan in the study of the more common etiologies of Addison's disease (tuberculosis, autoimmune, neoplastic metastasis and hemorrhage). It is concluded that the information obtained by CT scan is important in the etiological diagnosis of Addison disease and it is advised to perform it in all newly diagnosed cases.
