Estudio descriptivo de las desintoxicaciones de alcohol en un Servicio de Medicina Interna / No disponible

La dependencia al alcohol es una enfermedad crónica y su tratamiento comienza con la desintoxicación, continuándose con la rehabilitación. Se presenta un estudio descriptivo y retrospectivo de las desintoxicaciones de alcohol en 147 pacientes ingresados en nuestra unidad en el periodo 2003-2005. La media de edad es de 46.07 años, 77.6% hombres y 22.4% mujeres. Ingreso por síndrome de deprivación alcohólica en 31 pacientes (21.1%), desintoxicación programada en 116 pacientes (78.9%). Según la escala CIWA-Ar: abstinencia grado leve 100 pacientes (68.5%), moderada35 (24%), grave 11 (7.5%). La estancia media global fue de 11.5 días, sin diferencias estadísticamente significativas. Grupo Leve con proporción significativamente menor de hepatopatía, grupos Moderado y Grave proporción significativamente alta. Al compararla media de la edad, estancia, cantidad de alcohol y parámetros de consumo crónico (ferritina, fe, VCM, UBE, GPT, GGT, bilirrubina y Mg), se encuentran diferencias significativas entre las medias de los grupos Leve y Grave para la GPT y bilirrubina total. Se produjeron crisis epilépticas en 11 pacientes, 4 pertenecían al grupo programado,7 con intensidad moderada-grave. No se ha evidenciado relación entre la intensidad del síndrome de deprivación, edad y sexo. Mayor intensidad en la escala CIWA-Ar (grados moderado y grave) entre los pacientes con síndrome de deprivación ya iniciado comparados con los ingresados programados, que predominantemente presentaban un grado leve. La CIWA-Ar es un instrumento útil para evaluar los síntomas de deprivación, el riesgo de complicaciones y planificar el tratamiento. La actitud clínica debe facilitar el acceso del paciente a los recursos sanitarios para el tratamiento de su adicción, normalizando la asistencia durante el ingreso hospitalario

Alcohol dependence is a chronic disease whose treatment begins with detoxification, followed by rehabilitation. We present a descriptive and retrospective study of 147 patients admitted to our unit during the period 2003-2005. Median age was 46.07 years, with 77.6% men and 22.4% women. Admission diagnosis was alcohol with drawal syndrome in 31 patients (21.1%) and programmed alcohol detoxification in 116 patients (78.9%). On the CIWA-Ar scale: mild withdrawal, 100 patients (68.5%), moderate, 35 patients (24%), severe, 11 patients (7.5%). Mild group showed a statistically significantly lower proportion of hepatopathy, by comparison with the moderate and severe groups. Statistically significant differences were found between the mild and severe groups on comparing mean age, duration of stay, quantity of alcohol and parameters of chronic consumption (ferritine, fe, VCM, UBE,AST, bilirubin and Mg) for AST and bilirubin. There were 11 seizures: 4 patients from the programmed group, with mild with drawal on the CIWA-Ar scale, and 7 patients with moderate-severe with drawal. No relationship was found between patients’ intensity of with drawal syndrome, age or sex. There was higher intensity on the CIWA-Ar score (moderate and severe) among patients who had already begun with drawal syndrome, compared to those admitted on a planned detoxification programme. The CIWA-Ar is a useful tool for assessing with drawal symptoms and risks of complication and for planning treatment. Clinical practice must provide patients with access to health resources for the appropriate treatment of their addiction, with standardized assistance during their stay in hospital

Efficacy of atorvastatin for achieving cholesterol targets after LDL-cholesterol based dose selection in patients with type 2 diabetes.

We analyzed the feasibility of an intensive lipid-lowering strategy based on a starting dose of atorvastatin according to baseline and target low-density lipoprotein cholesterol (LDL-C) level (<2.6 mmol/L) in 202 statin-naïve patients with type 2 diabetes within 24 weeks. They were assigned to receive a daily dosage of atorvastatin based on their initial LDL-C levels. The primary endpoint was the proportion of patients achieving the LDL-C goal after 24 weeks of treatment. No changes were made in prescribed atorvastatin dosage. At the study end, 66.5% of the 188 patients completing the trial reached the LDL-C target (75%, 67%, 58% and 59% with 10, 20, 40 and 80 mg per day of atorvastatin, respectively) reached LDL-C target. Atorvastatin reduced the levels of total cholesterol, LDL-C, high density lipoprotein cholesterol (HDL-C) and triglycerides by 29%, 35%, 3% and 22%, respectively, and all statin doses were well tolerated. Thus, individualizing the starting dose of atorvastatin according to baseline and target LDL-C levels, allowed a high proportion of type 2 diabetic patients to achieve the target within 24 weeks.

Aportación de la tomografía por emisión de positrones al diagnóstico de un caso de acromegalia / Contribution of positron emission tomography to the diagnosis of a case of acromegaly

El diagnóstico de acromegalia está basado en pruebas bioquímicas que muestran un aumento de secreción de somatotropina (GH). Más del 95% de los pacientes con acromegalia presentan un adenoma hipofisario productor de GH. La técnica de imagen de elección en el diagnóstico del adenoma es la resonancia magnética (RM). La utilización de nuevas técnicas, como la gammagrafía con 111In-pentetreotida (OctreoScan) y la tomografía por emisión de positrones (PET), puede aportar información adicional en algunos casos. Presentamos el caso de una mujer diagnosticada de acromegalia. Varias RM y el OctreoScan fueron normales y otras posibilidades diagnósticas fueron descartadas. La PET localizó el origen hipofisario de la hipersecreción de GH. En la acromegalia, la ausencia de hallazgos en la RM y el diagnóstico de localización por medio de PET son excepcionales (AU)

Diagnosis of acromegaly is based on biochemical tests demonstrating increased growth hormone (GH) secretion. More than 95% of patients with acromegaly harbor a GH-secreting pituitary adenoma. The technique of choice in the diagnosis of an adenoma is magnetic resonance imaging (MRI). The use of new techniques such as 111In-octreotide scintigraphy (OctreoScan) and positron emission tomography (PET) can provide additional information in some cases. We report the case of a woman with acromegaly. The results of several MRI scans and OctreoScan were normal and other diagnostic possibilities were ruled out. The pituitary origin of the increased GH secretion was identified by PET. In acromegaly, the absence of MRI findings and identification of location by means of PET are exceptional (AU)

Contribution of positron emission tomography to the diagnosis of a case of acromegaly.

Diagnosis of acromegaly is based on biochemical tests demonstrating increased growth hormone (GH) secretion. More than 95% of patients with acromegaly harbor a GH-secreting pituitary adenoma. The technique of choice in the diagnosis of an adenoma is magnetic resonance imaging (MRI). The use of new techniques such as (111)In-octreotide scintigraphy (OctreoScan) and positron emission tomography (PET) can provide additional information in some cases. We report the case of a woman with acromegaly. The results of several MRI scans and OctreoScan were normal and other diagnostic possibilities were ruled out. The pituitary origin of the increased GH secretion was identified by PET. In acromegaly, the absence of MRI findings and identification of location by means of PET are exceptional.

Miopatía como presentación infrecuente de acromegalia / Myopathy as an unusual presentation of acromegaly

La miositis o miopatía inflamatoria es una manifestación frecuente de la acromegalia, aunque poco estudiada. Se caracteriza por debilidad de predominio proximal que puede acompañarse de dolor muscular. El incremento de las enzimas musculares, la alteración en el electromiograma y la biopsia compatible son hallazgos que apoyan el diagnóstico. Presentamos el caso de una paciente que consultó por debilidad muscular. Los estudios complementarios confirmaron la miositis y, tras descartar otras causas, se llegó al diagnóstico de acromegalia. La miositis como manifestación predominante de una acromegalia es excepcional (AU)

Myositis or inflammatory myopathy is a common but little-studied feature of acromegaly, characterized by predominantly proximal weakness that can be accompanied by muscle pain. Findings supporting a diagnosis of myositis are an increase in muscle enzymes, altered electromyography and characteristic biopsy results. We report the case of a patient who presented with muscle weakness. Complementary investigations revealed myositis and, after other causes were ruled out, a diagnosis of acromegaly was established. Myositis as the main manifestation of acromegaly is exceptional (AU)

Effects of diabetes on the osseointegration of dental implants.

The increased prevalence of diabetes mellitus has become a public health problem. Hyperglycaemia entails a rise in the morbidity and mortality of these patients. Although a direct relationship with periodontal disease has already been shown, little is known about the results of dental implants in diabetics. The present paper reviews the bibliography linking the effect of diabetes on the osseointegration of implants and the healing of soft tissue. In experimental models of diabetes, a reduced level of bone-implant contact has been shown, and this can be reversed by means of treatment with insulin. Compared with the general population, a higher failure rate is seen in diabetic patients. Most of these occur during the first year of functional loading, seemingly pointing to the microvascular complications of this condition as a possible causal factor. These complications also compromise the healing of soft tissues. It is necessary to take certain special considerations into account for the placement of implants in diabetic patient. A good control of plasma glycaemia, together with other measures, has been shown to improve the percentages of implant survival in these patients.

Effects of diabetes on the osseointegration of dental implants

El incremento en la prevalencia de la diabetes mellitus se ha convertido en un problema de salud pública. La hiperglucemia conlleva un aumento en la morbilidad y mortalidad de estos pacientes. Aunque ya se ha demostrado una relación directa con la enfermedad periodontal, poco se conoce sobre el resultado del implante dental en el sujeto diabético. En el presente trabajo se revisa la bibliografía que relaciona el efecto de la diabetes sobre la oseointegración de los implantes y la cicatrización de los tejidos blandos. En modelos experimentales de diabetes se ha demostrado una reducción en los niveles de contacto hueso-implante, que puede ser revertida mediante tratamiento con insulina. En el paciente diabético, comparado con la población general, se observa un mayor índice de fracaso. La mayoría de ellos se producen durante el primer año de carga funcional, lo que parece señalar a las complicaciones microvasculares de la enfermedad como posible factor causal. Dichas complicaciones comprometen también la cicatrización de los tejidos blandos. Se hace necesario establecer unas consideraciones especiales para la colocación de implantes en el paciente diabético. El buen control de la glucemia plasmática, junto con otras medidas, ha demostrado mejorar los porcentajes de supervivencia de los implantes en estos pacientes

The increased prevalence of diabetes mellitus has become a public health problem. Hyperglycaemia entails a rise in the morbidity and mortality of these patients. Although a direct relationship with periodontal disease has already been shown, little is known about the results of dental implants in diabetics. The present paper reviews the bibliography linking the effect of diabetes on the osseointegration of implants and the healing of soft tissue. In experimental models of diabetes, a reduced level of bone-implant contact has been shown, and this can be reversed by means of treatment with insulin. Compared with the general population, a higher failure rate is seen in diabetic patients. Most of these occur during the first year of functional loading, seemingly pointing to the microvascular complications of this condition as a possible causal factor. These complications also compromise the healing of soft tissues. It is necessary to take certain special considerations into account for the placement of implants in diabetic patient. A good control of plasma glycaemia, together with other measures, has been shown to improve the percentages of implant survival in these patients