Relación entre circunferencia de cintura y factores de riesgo metabólicos en mujeres argentinas / Relationship Between Waist Circumference and Metabolic Risk Factors in Argentine Women

Introducción: El síndrome metabólico (SM) agrupa factores de riesgo para enfermedad cardiovascular. Dentro de estos factores se encuentra la obesidad central, evaluada generalmente a través de la circunferencia de la cintura (CC) Objetivo: Analizar el comportamiento de las distintas variables que agrupan el SM (definición ATP III) en relación a los cambios en la CC. Sujetos: Se incluyeron 253 mujeres que concurrieron al Servicio de Endocrinología. Se evaluaron medidas antropométricas y presión arterial, así como glucemia en ayunas y lipidograma. Las pacientes fueron agrupadas por quintilos por CC: Q1 (56-80 cm), Q2 (80.1-89 cm), Q3 (89.1-96 cm), Q4 (96.1-103 cm) y Q5 (103.1-150 cm. Resultados: Existe una correlación positiva entre la CC y el IMC (p < 0,0001, r: 0,87).Asimismo, se observa una correlación positiva entre la CC y los valores de triglicéridos (p <0,0001, r: 0,28), glucemia (p = 0,0001, r: 0,24), presión arterial (PA) sistólica (p < 0,0001, r: 0,27) y diastólica (p < 0,0007, r: 0,21) y una correlación negativa entre la CC y los niveles de HDL (p < 0,0001, r: -0,25). Conclusiones: A medida que aumenta la CC, aumentan los factores de riesgo cardiovasculares (presión arterial diastólica, glucemia, triglicéridos, descenso del HDL).(AU)

Introduction: Metabolic syndrome (MS) is a group of risk factors for cardiovascular disease. These factors include central obesity, usually assessed through waist circumference (WC). Objective: To analyze the behavior of the different MS variables (ATP III definition) in relation to changes in WC. Subjects: We included 253 women who attended the Service of Endocrinology. We performed anthropometric, blood pressure, fasting glucose and lipid profile measurements. Patients were grouped into quintiles by WC: Q1 (56-80 cm), Q2 (80.1-89 cm), Q3 (89.1-96 cm), Q4 (96.1-103 cm) and Q5 (103.1-150 cm. Results: There is a positive correlation between WC and BMI (p < 0.0001, r = 0.87). In addition, there is a positive correlation between WC and triglyceride levels (p < 0.0001, r: 0.28), glucose (p = 0.0001, r = 0.24), systolic blood pressure (BP) (p < 0.0001, r = 0.27) and diastolic BP (p <0.0007, r: 0.21) and a negative correlation between WC and HDL levels (p < 0.0001, r = -0.25). Conclusions: As WC increases, cardiovascular risk factors (diastolic blood pressure, blood glucose, triglycerides, decreased HDL) increase.(AU)

Relación entre circunferencia de cintura y factores de riesgo metabólicos en mujeres argentinas / Relationship Between Waist Circumference and Metabolic Risk Factors in Argentine Women

Introducción: El síndrome metabólico (SM) agrupa factores de riesgo para enfermedad cardiovascular. Dentro de estos factores se encuentra la obesidad central, evaluada generalmente a través de la circunferencia de la cintura (CC) Objetivo: Analizar el comportamiento de las distintas variables que agrupan el SM (definición ATP III) en relación a los cambios en la CC. Sujetos: Se incluyeron 253 mujeres que concurrieron al Servicio de Endocrinología. Se evaluaron medidas antropométricas y presión arterial, así como glucemia en ayunas y lipidograma. Las pacientes fueron agrupadas por quintilos por CC: Q1 (56-80 cm), Q2 (80.1-89 cm), Q3 (89.1-96 cm), Q4 (96.1-103 cm) y Q5 (103.1-150 cm. Resultados: Existe una correlación positiva entre la CC y el IMC (p < 0,0001, r: 0,87).Asimismo, se observa una correlación positiva entre la CC y los valores de triglicéridos (p <0,0001, r: 0,28), glucemia (p = 0,0001, r: 0,24), presión arterial (PA) sistólica (p < 0,0001, r: 0,27) y diastólica (p < 0,0007, r: 0,21) y una correlación negativa entre la CC y los niveles de HDL (p < 0,0001, r: -0,25). Conclusiones: A medida que aumenta la CC, aumentan los factores de riesgo cardiovasculares (presión arterial diastólica, glucemia, triglicéridos, descenso del HDL).

Introduction: Metabolic syndrome (MS) is a group of risk factors for cardiovascular disease. These factors include central obesity, usually assessed through waist circumference (WC). Objective: To analyze the behavior of the different MS variables (ATP III definition) in relation to changes in WC. Subjects: We included 253 women who attended the Service of Endocrinology. We performed anthropometric, blood pressure, fasting glucose and lipid profile measurements. Patients were grouped into quintiles by WC: Q1 (56-80 cm), Q2 (80.1-89 cm), Q3 (89.1-96 cm), Q4 (96.1-103 cm) and Q5 (103.1-150 cm. Results: There is a positive correlation between WC and BMI (p < 0.0001, r = 0.87). In addition, there is a positive correlation between WC and triglyceride levels (p < 0.0001, r: 0.28), glucose (p = 0.0001, r = 0.24), systolic blood pressure (BP) (p < 0.0001, r = 0.27) and diastolic BP (p <0.0007, r: 0.21) and a negative correlation between WC and HDL levels (p < 0.0001, r = -0.25). Conclusions: As WC increases, cardiovascular risk factors (diastolic blood pressure, blood glucose, triglycerides, decreased HDL) increase.

[Treatment of isolated nocturnal enuresis: alarm or desmopressin?]. / Traitement de l'énurésie nocturne isolée: alarme sonore ou desmopressine?

BACKGROUND: Monosymptomatic nocturnal enuresis is common in healthy school children. Treatment is often required because of social and psychological convenience. We therefore conducted a randomized prospective trial using either desmopressin (D) or alarm (A). PATIENTS AND METHODS: Patients (n = 135) aged 6 to 16 years were enrolled between January 1992 and December 1994. Desmopressin (Minirin spray, Ferring SA) was given intranasally at a dose of 20 micrograms at bedtime and increased to 40 micrograms after 2 weeks if partial result was obtained. The alarm was a pad-bell device (Wet-stop, Sega) and the sound source was attached to the upper part of the pajamas. Inclusion criteria were: primary monosymptomatic nocturnal enuresis in healthy children, age > or = 6 years, absence of previous treatment using either desmopressin or alarm. The aim of the treatment was to achieve 100% dry nights. Patients were evaluated after 15 days on therapy by phone call and thereafter by attending the outpatient clinic at 2-3 and 4-6 months. At the time of the second evaluation, a switch from alarm to desmopressin (or vice-versa) was proposed to those who did not respond to the initial treatment. RESULTS: In group D (n = 62), only 27 children were included since 12 (19%) were switched to alarm and 23 (37%) were excluded because they were either non-compliant or lost to follow-up. In group A (n = 73), only 31 were included since six (8%) were switched to desmopressin and 36 (49%) were excluded for the same reasons as in group D. Prior to inclusion, the percentage of dry nights was 21% in group D and 14% in group A. After 15 days on therapy, patients from group D achieved 80% dry nights compared to 50% in group A (P = 0.001). After 3 months, patients from group D attained 85% dry nights vs 90% in group A. After 6 months, children from group A achieved 94% dry nights vs 78% in group D (P = 0.01). CONCLUSION: Desmopressin offers better short-term results than enuresis alarm but the latter is significantly more efficient in the long term. In France, the alarm device is not reimbursed by the national health service and therefore is poorly accepted, as suggested from the high rate of patients lost to follow-up.

Mycoplasma pneumoniae-associated nephritis in children.

Mycoplasma pneumoniae infection is a rare cause of acute nephritis. Six children (2 girls) aged 5-10 years, admitted for nephritis, had serological tests showing recent Mycoplasma pneumoniae infection. The diagnosis of Mycoplasma pneumoniae infection was based on the presence of serum IgM, detected either by immunofluorescence (IF) (n = 1) or enzyme-linked immunosorbent assay (n = 5). Four children had a renal biopsy, with analysis of parenchymal Mycoplasma pneumoniae components by indirect IF and polymerase chain reaction. Extrarenal symptoms were: respiratory (n = 3), ear, nose and throat (n = 2), gastrointestinal (n = 3), hepatic (n = 1), neurological (n = 1), articular (n = 1), and hematological (n = 3). The patients presented with acute nephritis (1 had a nephrotic syndrome) or with acute renal failure and proteinuria. Pathological findings included type 1 membranoproliferative glomerulonephritis (MPGN, n = 1), proliferative endocapillary glomerulonephritis (n = 2) and minimal change disease (n = 1). The patient with type 1 MPGN progressed rapidly towards end-stage renal failure because of a congenital solitary kidney. Among the patients with endocapillary glomerulonephritis, 1 relapsed 6 months later and remained proteinuric, while the other recovered, as did the child with minimal change disease. The search for Mycoplasma pneumoniae antigens and nucleic acids in renal tissue was negative. However, the absence of the microorganism in the kidney is a common feature of post-streptococcal glomerulonephritis. We conclude that Mycoplasma pneumoniae is a rare yet potential cause of acute glomerulonephritis.

Virilizing ovarian tumor of cell tumor type not otherwise specified: a case report.

Whereas ovarian tumors with overt endocrine manifestations account for less than 5% of all ovarian neoplasms, the incidence of virilizing type tumors in postmenopausal women is even lower since the average age of occurrence is 43 years. Steroid cell tumors not otherwise specified (NOS) are even more rare. We report the case of a 56-year-old woman (age of onset of menopause 43 years) who consulted our service due to a hyperandrogenic syndrome: deepening of the voice, temporal balding, hirsutism and cliteromegaly. Laboratory findings indicated hyperandrogenism in male range. The dexamethasone suppression test did not modify basal values, indicating that adrenal origin was unlikely. Transvaginal ultrasound disclosed multiple microcysts in the left ovary. Abdominal tomography was normal. Suspecting an ovarian tumor, bilateral oophorectomy was performed and a pediculate, 3 cm in diameter, was encountered in the left ovary. Histopathological studies determined it to be a virilizing ovarian tumor NOS. Postoperative recovery was fast; normal hormonal values were reached together with visible clinical improvement. This case is reported because this type of tumor is very infrequent in postmenopausal women, and because in this case it was the functional hormonal test that allowed tumor localization.

Outcome of preemptive renal transplantation and pretransplantation dialysis in children.

The present study compares the outcome of 40 children (39%) transplanted without prior dialysis, i.e., preemptive transplantation (PET), with 63 children (61%) transplanted after a variable duration of dialysis, i.e., pretransplantation dialysis (PTD). The two groups were matched for recipient and donor age and for immunological risk factors. There was no statistical difference in the time to first acute rejection episode nor in the number of acute rejection episodes during the 1st year after renal transplantation. In the PET group, 78% of the recipients received blood transfusion versus 92.5% in the PTD group (P < 0.05), and the average number of blood units per patient was 3.2 and 7.8, respectively (P < 0.05). Arterial hypertension was found in 55% of the patients in the PET group versus 73% in the PTD group (P < 0.05). The number of functioning grafts at the end of the study period was 87.5% in the PET group and 73% in the PTD group (NS). The major cause of graft failure was vascular thrombosis in the PET group (3/5) and chronic allograft rejection in the PTD group (10/17). In the PET group, the actuarial graft survival rate was 100%, 84%, 81%, and 76% at 1, 3, 5, and 7 years, which was not statistically different from the PTD group at 1, 3, and 5 years (98%, 91%, and 73%, respectively) but there was a significantly lower graft survival (59%) after 7 years in the PTD (P < 0.05). The 7-year actuarial patient survival rate was 97% in the PET group and 90% in the PTD group (NS). In the PTD group, children on dialysis for less than 1 year (group 1, n = 25) were compared with those on dialysis for more than 1 year (group 2, n = 38). Arterial hypertension was noted in 40% of patients from group 1 and 65% from group 2 (P < 0.05); there was no significant difference in graft loss rate. In conclusion, these results confirm PET as the preferred approach rather than PTD in children who need renal replacement therapy.

[Renal function after nephrectomy for Wilms' tumor]. / Fonction rénale après néphrectomie pour tumeur de Wilms.

BACKGROUND: Most children with Wilms tumour recover after nephrectomy, chemotherapy and sometimes radiotherapy. It is therefore important to assess their long-term renal function. POPULATION AND METHODS: Thirty-three patients with Wilms tumour experienced unilateral nephrectomy between 1986 and 1993: three were excluded; 23 were staged as grade I, one at grade II, two at grade III and four at grade IV. They were treated with SIOP 6 and SIOP 9 protocols. The results were compared to five controls who underwent unilateral nephrectomy including three for renal trauma. The glomerular filtration rate (GFR) was measured by inulin clearance and the renal plasma flow (RPF) by para-amino-hippuric acid clearance. RESULTS: The mean age at nephrectomy was 3.4 +/- 2.5 years (median: 3, range: 0.2-10.6) and the duration of follow-up was 4.6 +/- 3.1 years (median: 4.5, range: 1-8.5), the GFR was 93 +/- 13 mL/min/1.73 m2 (median: 93, range: 73-130), the RPF was 441 +/- 85 mL/min/1.73 m2 (median: 453, range: 236-650) and the filtrated fraction (FF) was 0.21 +/- 0.03 (median: 0.20, range: 0.18-0.31). The difference in renal function between patients and controls was not significant (GRF: 86 +/- 12 mL/min/1.73 m2, RPF: 486 +/- 185 mL/min/1.73 m2, FF: 0.22 +/- 0.03). The electrolyte reabsorption rate was normal and none of the patients suffered from arterial hypertension. Fourteen children had urinary albumin: creatinine ratio > 2 g/mol. When comparing patients according to the duration of follow-up after nephrectomy (< 4 years vs > 4 years), the renal function was not statistically different. The age at nephrectomy (< 2 years vs > 2 years) did not increase the risk of renal impairment. CONCLUSION: Children with Wilms tumour who were treated with nephrectomy and non-nephrotoxic drugs (actinomycin, vincristine, epiadriamycin) have a good long-term renal outcome. It is speculated that systematic renal investigation should be limited to those children with increased microalbuminuria and/or elevated blood pressure.

[Glomerulopathy and hypomelanosis of Ito]. / Glomérulopathie et hypomélanose de Ito.

Hypomelanosis of Ito is a rare neuroectodermal syndrome characterized by specific cutaneous lesions and frequent musculoskeletal or visceral involvement. We report on a child with an original nephritis with major segmental abnormalities of the glomerular basement membrane. Such an association might not be fortuitous and glomerular involvement might be underestimated in hypomelanosis of Ito.

Peripheral neuropathy in subclinical hypothyroidism.

Alterations in peripheral nerves are well documented in overt myxedema but not in subclinical hypothyroidism. We performed electrophysiologic studies to investigate such abnormalities in patients with normal serum total T4 and hyperresponsiveness of TSH to TRH, either with normal or high levels of basal circulating TSH. Subjects were divided in three groups: (i) Hypothyroidism Stage I (group () (n = 17, mean age = 39 +/- 34 years), T4 = 9 +/- 0.7 micrograms/dL, TSH = 4.3 +/- 0.4 microU/mL, sTSH post-TRH (peak value) = 37.6 +/- 1.6 microU/mL; (ii) Hypothyroidism Stage II (group II) (n = 10, mean age: 43 +/- 6 years), T4 = 7.7 +/- 0.8 microgram/dL, TSH = 20 +/- 5 microU/mL, TSH post-TRH > 50 microU/mL; (iii) Control Group (n = 20, mean age 41 +/- 5 years), healthy subjects. All patients and controls were women. TRH test consisted in the i.v. injection of 200 micrograms TRH (normal peak value up to 25 microU/mL, normal basal TSH < 5.5 microU/mL. None of the patients had carpal tunnel syndrome or any other neurological or metabolic disturbances. We studied the distal motor latencies, motor and sensory amplitudes, and nerve conduction velocities. The motor parameters were measured in the median and external sciatic popliteal (ESP) nerves, and the sensory parameters in the median and sural nerves. In most cases values were obtained from both right and left nerves. Motor parameters: no differences were found between all groups for conduction velocities (CV).(ABSTRACT TRUNCATED AT 250 WORDS)

Psychological changes during thyrotoxicosis.

Psychological changes during hyperthyroidism are well known. However, no studies were performed in order to quantify or evaluate them in numerical details. We have studied the personality of 15 women with Graves' disease by means of the 16PF Cattell Test, before and after treatment of hyperthyroidism with surgery or radioactive iodine. The first test was performed when patients relapsed the thyrotoxicosis after a period of euthyroidism, achieved through the treatment with antithyroid drugs during one year. At the time of the second test all patients had 6-12 months of euthyroidism. Hormonal circulating levels were as follow (mean +/- SEM): a) at the first test, T3 = 320 +/- 27 ng/dl, T4 = 19.7 +/- 1.2 micrograms/dl, TSH < 0.2 microU/ml; b) at the second test, T3 = 128 +/- 9 ng/dl, T4 = 8.8 +/- 0.8 micrograms/dl, TSH = 1.9 +/- 0.4 microU/ml. Differences between both tests were expressed for each factor as the mean difference +/- SEM (paired "t" test). After treatment patients were: 1) more relaxed and emotionally trustful and cooperative (factor A + 1.06 +/- 0.39, p < 0.02); 2) better and faster intellectual comprehension (factor B + 0.80 +/- 0.31, p < 0.05); 3) more capable of analysis (factor Q1 + 0.93 +/- 0.41, p < 0.05); 4) lower in lingering anxiety and tension (factor Q4-0.87 +/- 0.36, p < 0.05); 5) more independent, less submissive (factor QIV + 0.88 +/- 0.41, p < 0.05); 6) more relaxed (factor QI-0.69 +/- 0.20, p < 0.01). The other factors remained unchanged.(ABSTRACT TRUNCATED AT 250 WORDS)

[Percutaneous central venous catheters in neonatal intensive care. Personal experience]. / Les cathéters épicutanéo-caves en réanimation néonatale. Expérience personnelle.

The authors describe their own experience about using a siliconed percutaneous central venous catheter in the newborn, experience performed in their neonatal intensive care unit in Beirut. The technique consists in introducing this sort of device centrally by using a peripheral vein. The authors performed a prospective study on thirty-two newborns: Their results seem to indicate, in accordance to the literature review, that this technique offers many advantages such as sparing the newborn veins, prolonged hyperalimentation and treatment, and less incidents than the other perfusion techniques (peripheral and central). Few inconveniences are encountered: limitation of the amount of daily perfusion, impossibility of transfusing blood or derivatives across the silicone catheter.

Pielonefritis enfisematosa / Emphysematous pyelonephritis

La pielonefritis enfisematosa es una infección del parénquima renal asociada con la producción de gas, el que se localiza en el parénquima renal y puede extenderse al espacio perirrenal. Se presenta el caso de una mujer de 61 años con pielonefritis enfisematosa diabética, con obstrucción ureteral, urocultivo y homocultivo positivos para Escherichia coli, comprobándose en la autopsia alteraciones histológicas que corroboran las características clínicas de enfisema renal y perirrenal, resultando este caso, de especial interés por la bilateralidad de las lesiones. Esta enfermedad es poco frecuente y afecta a pacientes con diabetes mellitus y obstrucción ureteral. La producción de gas se debe a la acción de bacterias anaeróbicas facultativas que fermentan la glucosa y producen ácido láctico y dióxido de carbono. El tratamiento se fundamenta en la reposición hidroelectrolítica, control del estado ácido base, corrección de la descomposición diabética y antibiótico-terapia. Se destacan las ventajas del tratamiento quirúrgico precoz, basado en la nefrectomía y/o en el drenaje del espacio perirrenal

Pielonefritis enfisematosa / Emphysematous pyelonephritis

La pielonefritis enfisematosa es una infección del parénquima renal asociada con la producción de gas, el que se localiza en el parénquima renal y puede extenderse al espacio perirrenal. Se presenta el caso de una mujer de 61 años con pielonefritis enfisematosa diabética, con obstrucción ureteral, urocultivo y homocultivo positivos para Escherichia coli, comprobándose en la autopsia alteraciones histológicas que corroboran las características clínicas de enfisema renal y perirrenal, resultando este caso, de especial interés por la bilateralidad de las lesiones. Esta enfermedad es poco frecuente y afecta a pacientes con diabetes mellitus y obstrucción ureteral. La producción de gas se debe a la acción de bacterias anaeróbicas facultativas que fermentan la glucosa y producen ácido láctico y dióxido de carbono. El tratamiento se fundamenta en la reposición hidroelectrolítica, control del estado ácido base, corrección de la descomposición diabética y antibiótico-terapia. Se destacan las ventajas del tratamiento quirúrgico precoz, basado en la nefrectomía y/o en el drenaje del espacio perirrenal (AU)