Assuntos
Neoplasias das Glândulas Suprarrenais/complicações , Oxigenação por Membrana Extracorpórea , Feocromocitoma/complicações , Choque Cardiogênico/terapia , Cardiomiopatia de Takotsubo/terapia , Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Neoplasias das Glândulas Suprarrenais/cirurgia , Adrenalectomia , Adulto , Terapia Combinada , Dobutamina/uso terapêutico , Emergências , Feminino , Humanos , Hipertensão/etiologia , Insuficiência de Múltiplos Órgãos/etiologia , Insuficiência de Múltiplos Órgãos/terapia , Norepinefrina/uso terapêutico , Feocromocitoma/diagnóstico por imagem , Feocromocitoma/cirurgia , Respiração Artificial , Choque Cardiogênico/etiologia , Cardiomiopatia de Takotsubo/etiologia , Tomografia Computadorizada por Raios XRESUMO
La necesidad de conseguir un adecuado tratamiento sustitutivo en la diabetes mellitus tipo 1 (DM1) ha ido dirigida a obtener una adecuada imitación de la secreción endógena de insulina y su comportamiento fisiológico ante los picos de hiperglucemia. Esto ha planteado dos grandes retos: la obtención de nuevas insulinas y el desarrollo de nuevas formas de administración de insulina. En relación a las nuevas insulinas, los primeros resultados se obtuvieron con la consecución de análogos de insulina de acción rápida (lispro y aspart). Posteriormente se han desarrollado análogos de insulina de acción prolongada (glargina y detemir), cuyo comportamiento es más uniforme. El desarrollo de las nuevas formas de administración de insulina se ha basado fundamentalmente hasta la fecha en el uso de la infusión subcutánea continua de insulina(ISCI), cuyas ventajas teóricas se basan en dos principios básicos: sólo se usa insulina rápida, la cual se administra en infusión continua y en bolos, y la infusión es además programable, debiendo tenerse en cuenta que la ausencia de autonomía de los ISCI requiere una importante implicación del paciente en su tratamiento
The need for an ideal substitute therapy in type 1 Diabetes Mellitus(DM1) has been directed to imitate the endogenous insulin secretion and its physiological response against the peaks of hyper-glycaemia. This has raised two great challenges: the discovery of new insulins and the development of new methods of insulin delivery. In relation to new insulins, the development of short acting insulin analogs (lispro and aspart) was a great achievement, but intensive therapy with multiple doses of insulina (MDI) also needed the use of long-acting insulin analogs (glargine and determir) with a more uniform pharmacological profile. On the other hand, to date, new forms of insulin delivery has been based mainly on the use of continuous subcutaneous insulin infusion (CSII), which theoretical advantages are based on two basic principles: the only use of rapid-acting insulin administered either as continuous infusion or bolus. In addition, the insulin infusion is also programmable. Its lack of autonomy requires an important implication of the patient in the therapy
Assuntos
Masculino , Feminino , Humanos , Sistemas de Infusão de Insulina , Diabetes Mellitus Tipo 1/terapia , Diabetes Mellitus/dietoterapia , Diabetes Mellitus/terapia , Insulina/uso terapêutico , Sistemas de Infusão de Insulina/tendênciasRESUMO
Gestational primary hyperparathyroidism presents with features which, from a physiological and prognostic viewpoint, entail great difficulty in diagnosis and a high risk of complications. These complications occur at rates of 67% and 80% in the mother and fetus, respectively, and can be reduced by up to four times by means of prompt application of effective therapeutic measures. We report a case involving a pregnant woman in the 16th week of gestation who presented with asymptomatic hypercalcemia secondary to a solitary parathyroid adenoma. When the patient did not improve after conservative therapeutic measures, it was decided to employ surgical treatment in the second trimester of pregnancy. The surgery was successful, and the follow-up period was without complications for the mother and neonate. We therefore agree with the growing evidence that surgery in the second trimester of pregnancy constitutes a safe and effective alternative to conservative treatment.
Assuntos
Hiperparatireoidismo/diagnóstico , Complicações na Gravidez , Adenoma/complicações , Adenoma/cirurgia , Adulto , Feminino , Idade Gestacional , Humanos , Hipercalcemia/etiologia , Hiperparatireoidismo/complicações , Hiperparatireoidismo/cirurgia , Neoplasias das Paratireoides/complicações , Neoplasias das Paratireoides/cirurgia , Gravidez , Resultado da GravidezRESUMO
No disponible
Assuntos
Humanos , Compostos de Sulfonilureia , Biguanidas , Quimioterapia Combinada , Algoritmos , Hipoglicemiantes , Diabetes Mellitus Tipo 2 , alfa-GlucosidasesRESUMO
Pheochromocytoma is a rare cause of hypertension. Its coexistence with pregnancy is exceptional and laparoscopic removal has rarely been reported. We describe the case of a 34-year-old woman with multiple endocrine neoplasia type 2a (MEN 2a) with adrenal pheochromocytoma diagnosed in the 6th week of pregnancy. After pretreatment with phenoxybenzamine, a successful transperitoneal laparoscopic adrenalectomy was performed in the twentieth week of gestation. The management of pheochromocytoma in pregnancy and the indications for laparoscopic surgery in pregnant patients are discussed.
