Diabetes mellitus after kidney transplantation: role of the impaired fasting glucose in the outcome of kidney transplantation.

INTRODUCTION: Most patients suffering from chronic renal insufficiency show impaired carbohydrate metabolism. Our goals were to analyze the accumulated incidence of impaired fasting glucose (IFG) and post-transplant diabetes mellitus (PTDM) after kidney transplantation in our hospital, to assess their impacts on the survival of the graft and of the patient, and to discover the major risk factors for the development of PTDM. MATERIALS AND METHODS: We examined alterations in carbohydrate metabolism in 920 adult patients after they received kidney transplantation. Patients were followed for a minimum period of 5 yr. RESULTS: One year after transplantation, 12.8% of the patients had developed PTDM, and 10.3% showed an IFG level. The IFG had a negative and statistically significant influence on graft and patient survival. Host and donor age, weight, hepatitis C virus infection, and acute rejection were found to be significant risk factors. DISCUSSION: Our study found a high incidence of PTDM, as described in previous studies, but with an emphasis on a greater role played by IFG, not only in its incidence, but also as a prognostic factor for the outcome of graft and patient survival. Identifying patients at risk of developing PTDM is important in offering them early and appropriate treatment.

Diabetes mellitus y otros factores de riesgo cardiovascular mayores en una población del Mediterráneo español. Estudio Burriana / Diabetes mellitus and other major cardiovascular risk factors in a Mediterranean population in Spain. A study in Burriana

Objetivo: Se realizó un estudio poblacional, transversal, aleatorizado y estratificado con objeto de determinar la prevalencia de la diabetes mellitus tipo 2 (DM2) y otros factores de riesgo cardiovascular en una ciudad representativa del Mediterráneo español. Diseño y métodos: El estudio se llevó a cabo en Burriana, Comunidad Valenciana (27.144 habitantes) en 375 personas de edades comprendidas entre los 30 y los 80 años, que se estratificaron por edad y sexo. Se midieron los parámetros antropométricos y de bioquímica sanguínea (glucemia, insulinemia y otros). Se realizó una sobrecarga oral de glucosa (Organización Mundial de la Salud [OMS], 1985) en aquellas personas sin historia de DM2 y cuya glucemia digital previa fuese inferior a 140 mg/dl. Resultados: La prevalencia de diabetes mellitus (OMS, 1985) fue del 12,8% (un 9,3% conocida). La tolerancia alterada a la glucosa mostró valores del orden de la diabetes con un 10,8% para los varones y un 9% para las mujeres. La prevalencia de hipertensión arterial (JNC-VI, OMS-ISH) fue del 29,1%. Se encontró hipercolesterolemia (ATP III) en el 37,8% de los participantes. La obesidad (índice de masa corporal [IMC] > 30 kg/m2) afectó al 30,9%, y el 25,3% de la población estudiada declaró hábito tabáquico. Conclusiones: La prevalencia de DM2, intolerancia a la glucosa y obesidad en Burriana (Mediterráneo español) es alta en comparación con estudios españoles semejantes. Otros factores de riesgo cardiovascular mostraron valores parecidos a los de los estudios citados (dislipemia) o inferiores (hipertensión, hábito tabáquico)

Objective: This randomized, multistage, cross sectional population survey was undertaken to determine the prevalence of type 2 diabetes mellitus (DM2) and other cardiovascular risk factors in a representative Mediterranean city in Spain. Research design and method: The study was carried out in Burriana (27,144 inhabitants, autonomous community of Valencia) in 375 persons aged 30-80 years old stratified by age and sex. Anthropometric parameters and biochemical tests (fasting glucose, insulinemia, and other) were measured. Oral glucose load (WHO 1985) was performed in subjects without a history of DM2 and when previous digital glycemia was 30) was 30.9%. Smoking was reported by 25.3% of the population studied. Conclusions: The prevalence of DM2, glucose intolerance and obesity in Burriana (Spanish Mediterranean) is higher than reported prevalences in comparable Spanish surveys. Values for other cardiovascular risk factors were similar to (dyslipidemia) or lower than (hypertension, smoking) previously reported data

Plasma cell granuloma of the thyroid and Hashimoto thyroiditis.

Plasma cell granuloma of the thyroid is a rare tumor-like lesion formed by a localized proliferation of inflammatory cells, supported by a stroma of fibrous tissue. Few cases have been previously reported in the medical literature. We report a new case of a 41-year-old man presenting a goiter with primary hypothyroidism (thyroid-stimulating hormone, 70 mIU/L; free thyroxine, < 0.01 pmol/L; triiodothyronine, 0.66 nmol/L) and elevation of thyroid antibodies. Several fine-needle aspiration biopsies of the thyroid were fruitless and total thyroidectomy was performed. Histologic and immunohistochemical study demonstrated the polyclonal nature of the cells and yielded a diagnosis of plasma cell granuloma. Histologic findings of Hashimoto thyroiditis were present too.

Metástasis poco habituales del carcinoma diferenciado de tiroides / Less common sites of metastases in differentiated thyroid cancer

El carcinoma diferenciado de tiroides metastatiza fundamentalmente en pulmón y hueso, y con menos frecuencia en cerebro, hígado y piel. Se describen las características clínicas, terapéuticas e histológicas del tumor primario en tres casos de metástasis de carcinoma diferenciado de tiroides en lugares poco habituales. En dos de los casos se trataba de un carcinoma folicular, el primero presentó una metástasis en glándula suprarrenal derecha y el segundo en riñón izquierdo. En los dos casos, inicialmente, sólo se realizó una hemitiroidectomía sin tratamiento posterior con I131, y en uno de ellos no se trataron cifras elevadas de tiroglobulina en el seguimiento por ser los rastreos con I131 negativos. En el tercer caso el diagnóstico anatomopatológico inicial fue de carcinoma papilar, procediéndose a tiroidectomía total más ablación de restos con I131 y tratamiento supresor con levotiroxina, sin embargo, la evolución posterior fue desfavorable presentando metástasis en lugares típicos y atípicos como fue en coroides. La revisión de la pieza histológica del último caso reveló una variedad de células altas del carcinoma papilar de tiroides. En conclusión, ante un carcinoma diferenciado de tiroides cuyo tratamiento inicial no haya sido el correcto, es posible encontrar metástasis en los lugares habituales y también en otros más infrecuentes. Determinadas variedades del carcinoma papilar de tiroides como es la de células altas, presentan un comportamiento especialmente agresivo y pueden metastatizar en lugares poco habituales (AU)

[Unusual metastasis of differentiated thyroid carcinoma]. / Metástasis poco habituales del carcinoma diferenciado de tiroides.

Distant metastases of differentiated thyroid cancer are usually localised in the lung and bone; less common sites of metastases are the brain, liver, and skin. To find it in other sites it is exceptional. This work shows the clinical, histological and therapeutical characteristic of primary tumour in three cases of non-typical distant metastases of differentiated thyroid cancer. Follicular thyroid carcinoma was displayed in two cases, the first presented one metastases in right adrenal gland and the second in left kidney. Both cases were initially treated only with hemithyroidectomy, without posterior radioiodine. In one case, elevated serum thyroglobulin did not receive radioiodine treatment because Whole-Body Scintigraphy was negative. The thirst case was a papillary thyroid carcinoma treated with total thyroidectomy, ablative radioiodine and suppressor therapy with levothyroxine. However, posterior evolution was unfavourable and tumour presented metastases in common and less common sites like choroid. Histological study showed tall cell variant of papillary thyroid carcinoma. In summary, when the initial treatment of well-differentiated thyroid carcinoma it is inaccurate, it is possible to find common and less common sites metastases. Some variants of papillary thyroid carcinoma, like tall cell, have a worse prognosis and they can present metastases in less common sites.

[Thyroid lymphoma: a not so unusual disease]. / Linfoma de tiroides: una patología no tan excepcional.

A review was made of the six cases of primary thyroid lymphoma diagnosed at our institution. An increase in the incidence was observed of this disease in the last two years, with no evidence of lower diagnosis of anaplastic thyroid carcinoma. The presenting symptom was compression in all cases. The interval time from symptoms to diagnosis ranged from 5 to 150 days. The centroblastic pattern was the most common histologic type, with a relevant role of MALT lymphoma in the last few years. Therapy included surgical exeresis in two cases on account of compressive symptoms and radiotherapy and/or chemotherapy was always preferred on account of the stage.

[Brown tumor of the maxilla as initial manifestation of primary hyperparathyroidism]. / Tumor pardo del maxilar como manifestacion inicial de hiperparatiroidismo primario.

The paper reports the case of a maxillary brown tumor as early sign of primary hyperparathyroidism. Brown tumors are very unusual growths in daily ENT practice and an odd start of primary hyperparathyroidism. The AA. emphasize the importance of a correct differential diagnosis, especially with those tumors showing multinucleated giant cells (osteoclast type)--such as true giant cells tumor and central giant granuloma--prior to its management. They also comment on the interesting contribution to diagnosis by imagery brought by CT scan, magnetic resonance (MR), ultrasonography (echography) and digital subtraction gammagraphy to attain the topographic site of the parathyroid tumor.

[Treatment of thyroid cancer in our field: attitude regarding lymph node surgery]. / Tratamiento del cáncer tiroideo en nuestro medio: actitud respecto a la cirugía ganglionar.

We comment our attitude in dealing with lymph nodes and thyroid gland surgery for thyroid cancer. This was based on our 10 years experience with such surgery, in which we have performed 350 chirurgic interventions. Of them, in 55 cases a thyroid carcinoma was detected (36 papilar, 13 follicular, 4 medular, 1 anaplasic and 1 metastasic clear-cell carcinoma).